Rapid inpatient switch to oral PAH therapy appears safe in study
Transition to Uptravi typically involved four steps over a median 36 hours
Written by |
Adults with pulmonary arterial hypertension (PAH) taking Remodulin (treprostinil) or Veletri (epoprostenol) safely switched to Uptravi (selexipag) during carefully monitored hospital stays using a rapid dose-titration plan, a new study reports.
The findings may help guide clinicians who are transitioning appropriate PAH patients from infusion therapy to an oral alternative, researchers said. The study, “Transitions From Parenteral Prostacyclin Analogues to Selexipag in Patients With Pulmonary Arterial Hypertension,” was published in Pulmonary Circulation.
PAH is marked by elevated pressure in the lungs’ blood vessels. Prostacyclin pathway agents, or PPAs, are medications that act on the prostacyclin pathway to help widen blood vessels and reduce blood pressure in the lungs. A range of different PPAs are approved to treat PAH. Some of them, known as parenteral PPAs, are administered by infusion into the bloodstream or under the skin.
Infused prostacyclin therapies can be effective but burdensome
Remodulin and Veletri are both parenteral PPAs that are approved in the U.S. for PAH. Remodulin is approved to reduce symptoms associated with exercise, while Veletri is approved to improve exercise capacity. Because both are given by continuous infusion, treatment can be burdensome.
“Parenteral PPAs are continuous infusion medications that are complicated to use and can be associated with bloodstream infections if administered [by infusion into the bloodstream], or with infusion site pain if administered [under the skin]. Consequently, patients on these therapies frequently require or request transition to an oral prostacyclin pathway agent,” the researchers wrote.
Uptravi is an oral PPA that is approved to treat PAH, so it may be an attractive alternative for some patients who need or want to stop parenteral PPAs. But stopping one medication and starting another can pose safety risks, and very little has been published about how doctors should manage the transition from parenteral PPAs to Uptravi. Aiming to fill that gap, researchers reported outcomes from 35 adults with PAH, with a median age of 61, who switched from Remodulin or Veletri to Uptravi during hospital stays at the University of Cincinnati Medical Center in Ohio.
“There is very little published data on transitioning from parenteral PPAs to [Uptravi] and questions remain about the optimal approach to transition,” the researchers wrote. “This study aimed to describe processes and outcomes associated with inpatient transitions from parenteral PPA to oral [Uptravi] in a small, single-center cohort of PAH patients.”
Most transitions (77%) were planned before patients were admitted to the hospital. The most common reason for switching was a barrier to continuing infusion therapy, including infusion-site problems, intravenous access issues, or caregiver-related difficulties. The remaining 23% of transitions were unplanned, meaning the decision to switch was made during the hospital stay.
Hospital protocol gradually shifts patients to oral Uptravi
The transition protocol involved gradually decreasing the dose of parenteral PPAs while simultaneously increasing the dose of Uptravi during a hospital stay. The therapies were overlapped to avoid abruptly stopping the parenteral treatment. The researchers noted that, although each patient’s specific dose schedule was personalized, “the bulk of the transition plan was standardized.”
The transition from parenteral PPAs to Uptravi was completed rapidly, with a median duration of 36 hours. After the switch, PAH risk scores and functional status generally remained stable. Functional status reflects how much PAH symptoms limit a person’s daily activities. The researchers noted that outcomes were similar whether or not the transition was planned in advance.
“Rapid transition from parenteral PPA to [Uptravi] can be performed in a safe and effective way for patients in a hospitalized setting with careful monitoring,” the researchers concluded.
The scientists said their experience could help guide clinicians who are transitioning patients from parenteral PPAs to Uptravi. However, they stressed that their results were limited by the small, single-center study population and the specialized hospital setting where the transitions were performed. “Future research to evaluate candidacy for transition, tolerance of transition, and a protocolized approach to dosage selections are needed to further optimize the transition approach to patients on parenteral PPA’s,” they said.
Leave a comment
Fill in the required fields to post. Your email address will not be published.