Table 1.
Intra-class PAH medication transitions: infused prostacyclin analogue to another infused prostacyclin analogue.
| No. | Original drug | Drug transitioned to | Publication year/ Authors | Study design | PAH patients | Time | Outcome (transition success) | Comments |
|---|---|---|---|---|---|---|---|---|
| Prospective | ||||||||
| 1 | IV epoprostenol | SQ treprostinil | 2007 / Rubenfire et al.12 | Prospective randomized placebo-controlled trial | 22 | 8 weeks | Successful in 13/14 patients randomized to transition to SQ treprostinil | Patients had stable WHO FC II or III disease 6MWD worsened by 35 m after transition to SQ treprostinil |
| 2 | IV epoprostenol | IV treprostinil | 2005 / Gomberg- Maitland et al.27 | Prospective open-label | 31 | 3 months | Successful in 27/31 patients | WHO FC, 6MWD were unchanged Hemodynamics worse |
| 3 | IV epoprostenol | IV treprostinil | 2007 / Sitbon et al.28 | Prospective open-label | 12 (NYHA class I or II) | 3 months | Successful in 12/12 patients | Epoprostenol dose 28 ± 14 ng/kg/min Treprostinil dose 62 ± 30 ng/kg/min Fewer adverse events and all remained on treprostinil |
| 4 | IV epoprostenol | IV treprostinil | 2013 / Benza et al.15 | Prospective open-label | 31 transition patients (out of total of 47 patients reported, 16 of which are de novo) | 11 months | Successful transition (defined as freedom from death, lung transplantation, atrial septostomy, or discontinuation of IV treprostinil) in 77% of transition patients | No change in exercise capacity, WHO FC or hemodynamics at 11 months Two transition patients died and six discontinued the study due to adverse events |
| 5 | IV epoprostenol | IV treprostinil | 2013 / Minai et al.29 | Prospective open-label | 10 | 8 weeks | Successful in 10/10 patients | No change in 6MWD; no worsening WHO FC; improved QOL and satisfaction, less time on drug prep activities |
| 6 | IV epoprostenol | IV thermostable epoprostenol | 2013 / Tamura et al.30 | Prospective open-label | 8 | 12 weeks | Successful in 8/8 patients | No safety events or change in hemodynamics, improved satisfaction scores |
| 7 | IV epoprostenol | IV thermostable epoprostenol | 2014 / Sitbon et al.31 | Prospective open-label | 41 | 3 months | Successful in 37/41 patients | TSQM scores showed an improvement in treatment convenience at 3 months |
| 8 | IV epoprostenol | IV thermostable epoprostenol | 2015 / Provencher el al.32 | Prospective open-label | 16 | 4 weeks | Successful in 16/16 patients | No change in SF-36 HRQoL, WHO FC, 6MWD, NT-proBNP Most patients preferred the thermostable product |
| 9 | IV epoprostenol | IV thermostable epoprostenol | 2015 / Frantz et al.14 | Prospective open-label registry | 189 transition patients (out of a total cohort of 336 patients) | 12 months | Successful in 132/189 PAH transition patients | Freedom from hospitalization: 57.1 ± 3.7%; 1-year survival: 87.7 ± 2.5% |
| Retrospective | ||||||||
| 10 | IV epoprostenol | SQ treprostinil | 2002 / Vachiéry et al.33 | Retrospective | 8 | 4–11 months | Successful in 7/8 patients | Transition achieved in 21–96 h, with no major adverse effects or worsening in clinical status All patients reported improved comfort at follow-up |
| 11 | SQ treprostinil | IV treprostinil or IV epoprostenol | 2014 / Alkukhun et al.34 | Retrospective | 9 (7 with PAH, 2 with CTEPH) | 12 months | Successful in 8/9 patients | Reasons for SQ to IV switch were site pain (n = 6), major surgery (n = 2) and septic shock (n = 1) SQ treprostinil to IV treprostinil: dose = 84.9 to 70.8 ng/kg/min SQ treprostinil to IV epoprostenol: dose = 24.5 to 13.3 ng/kg/min |
6MWD, 6-minute walk distance; FC, functional class; HRQoL, health-related quality of life; IV, intravenous; mPAP, mean pulmonary artery pressure; N/A, not applicable; NT-proBNP, N-terminal pro B-type natriuretic peptide; NYHA, New York Heart Association; QOL, quality of life; SF-36, short form (36) health survey; SQ, subcutaneous; TSQM, treatment satisfaction questionnaire for medication; WHO, World Health Organization.