Parenteral treprostinil induction for rapid attainment of therapeutic doses of oral treprostinil - 31/10/23
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Abstract |
Rationale |
Oral treprostinil slows disease progression and improves exercise capacity in pulmonary arterial hypertension; however, titration can be prolonged. Published data suggests prostacyclin-naïve patients achieve total daily oral treprostinil doses of about 6 mg by Week 16, while those on prior parenteral treprostinil reach higher doses at the same timepoint.
Objectives |
EXPEDITE (NCT03497689), a single-arm, multicenter study, assessed the efficacy of rapid parenteral treprostinil induction to quickly reach higher doses of oral treprostinil for the treatment of pulmonary arterial hypertension.
Methods |
Parenteral treprostinil was titrated for 2–8 weeks, followed by cross-titration of oral treprostinil. The primary endpoint was percentage of patients reaching ≥12 mg daily of oral treprostinil at Week 16. Secondary endpoints included clinical changes from baseline to Week 16.
Results |
Twenty-nine prostacyclin-naïve patients were included in efficacy analyses. At Week 16, the mean daily oral treprostinil dose was 16.4 mg; 79% of patients met the primary endpoint. From baseline to Week 16, median REVEAL Lite 2 score improved (decreased) from 6 to 3.5 (p = 0.0006). Statistically significant improvements were also seen in World Health Organization Functional Class, N-terminal-pro brain natriuretic peptide levels, 6-minute walk distance, right atrial area, Borg Dyspnea Score, and emPHasis-10 score. Favorable trends were seen in risk stratification, echocardiography parameters, disease symptoms, and treatment satisfaction.
Conclusion |
Short-course parenteral treprostinil induction resulted in oral treprostinil doses over twice those reported in de novo initiations and may be a useful approach to quickly achieve the therapeutic benefits of oral treprostinil.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | Rapid parenteral treprostinil induction and cross-titration to oral treprostinil. |
• | Safe and effective approach to reach higher doses of oral treprostinil quickly. |
• | Total daily dose >2× (16.4 mg) vs. previously reported de novo dosing. |
• | Significant improvement in WHO FC, NT-proBNP, 6MWD, and risk status at Week 16. |
• | Improved echo parameters and attainment of low-risk status in most patients. |
Keywords : Pulmonary arterial hypertension, Prostacyclin, Cross-titration
Plan
Vol 218
Article 107374- novembre 2023 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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