Transition from Parenteral to Oral Prostacyclin Agents in Pulmonary Arterial Hypertension in Ambulatory Care Setting: A Tertiary Care Institutional Experience

PurposeProstacyclins are used to treat advanced pulmonary arterial hypertension as continuous intravenous or subcutaneous infusions. In the right clinical setting, parenteral Prostacyclins can be transitioned to newer oral Prostacyclins. There is a dearth of published guidance for this transition and is limited to inpatient setting. We present our experience with transitioning patients with WHO group 1 pulmonary arterial hypertension from parenteral Treprostinil to oral Treprostinil in the outpatient setting.Methods6 patients with WHO group 1 pulmonary arterial hypertension on stable doses of intravenous or subcutaneous Treprostinil for at least 6 months were transitioned to oral Treprostinil as per published protocol albeit at a slower rate of transition at 6 ng/kg/min per dayResultsAll the 6 patients were successfully transitioned from Parenteral Treprostinil to oral Treprostinil and 4 remain on oral therapy for 1- 4 years. The reasons for transition include complications of central line, side effects related to parenteral Prostacyclins and personal preference. Two patients deteriorated over 6-12 months after the transition requiring transition back to parenteral Treprostinil. No deterioration in PAH was noted during the transition. High 6 MWD, High WHO FC (1/2) and normal RV function on parenteral Prostacyclins are associated with successful results.ConclusionIn the right clinical setting, patients can be successfully transitioned from parenteral Treprostinil to oral Treprostinil and this can be accomplished safely in the outpatient setting. Prostacyclins are used to treat advanced pulmonary arterial hypertension as continuous intravenous or subcutaneous infusions. In the right clinical setting, parenteral Prostacyclins can be transitioned to newer oral Prostacyclins. There is a dearth of published guidance for this transition and is limited to inpatient setting. We present our experience with transitioning patients with WHO group 1 pulmonary arterial hypertension from parenteral Treprostinil to oral Treprostinil in the outpatient setting. 6 patients with WHO group 1 pulmonary arterial hypertension on stable doses of intravenous or subcutaneous Treprostinil for at least 6 months were transitioned to oral Treprostinil as per published protocol albeit at a slower rate of transition at 6 ng/kg/min per day All the 6 patients were successfully transitioned from Parenteral Treprostinil to oral Treprostinil and 4 remain on oral therapy for 1- 4 years. The reasons for transition include complications of central line, side effects related to parenteral Prostacyclins and personal preference. Two patients deteriorated over 6-12 months after the transition requiring transition back to parenteral Treprostinil. No deterioration in PAH was noted during the transition. High 6 MWD, High WHO FC (1/2) and normal RV function on parenteral Prostacyclins are associated with successful results. In the right clinical setting, patients can be successfully transitioned from parenteral Treprostinil to oral Treprostinil and this can be accomplished safely in the outpatient setting.