Experience in Transitioning From Parenteral Prostacyclins to Selexipag in Pulmonary Arterial Hypertension.

Parikh, Kishan S

Doerfler, Sean

Shelburne, Nicholas

Kennedy, Karla

Whitson, Jordan

Dahhan, Talal

Fortin, Terry

Rajagopal, Sudarshan

2021-02-01T15:15:27Z

2021-02-01T15:15:27Z

2020-04

2021-02-01T15:15:26Z

Parenteral prostacyclin therapies remain first-line therapy for patients with pulmonary arterial hypertension (PAH) with class IV symptoms. In selected patients who have been clinically stabilized, switching to selexipag, a chemically distinct prostacyclin receptor agonist, may alleviate risks associated with long-term parenteral therapy. We report our experience with transition of patients from parenteral prostacyclin therapy to selexipag. From January 2016 to July 2017, patients with PAH at the Duke University Pulmonary Vascular Disease Center with functional class II symptoms on stable parenteral prostacyclin therapy were offered the opportunity to transition to selexipag. A standardized protocol was developed to guide titration of therapies. Patients underwent pre- and post-transition assessments of hemodynamics, echocardiography, laboratory biomarkers, and functional status. We studied 14 patients with PAH (11 women; median age 53 years) in total. Overall, 13 patients tolerated the switch to selexipag and remained on the drug at study completion, and 1 patient passed away due to progressive liver failure. Surrogate markers including NT-proBNP, 6MWD, RV function, and TAPSE, and right heart catheterization hemodynamics were similar before and after transition. The transition from parenteral prostanoid therapy to oral selexipag was overall well-tolerated in patients with stable PAH and functional class II symptoms. Finally, doses of selexipag up to 3200 μg twice daily were well-tolerated in patients who had been treated with prior parenteral prostacyclins.

0160-2446

1533-4023

https://hdl.handle.net/10161/22291

eng

Ovid Technologies (Wolters Kluwer Health)

Journal of cardiovascular pharmacology

10.1097/fjc.0000000000000800

Pulmonary Artery

Humans

Acetamides

Pyrazines

Prostaglandins I

Receptors, Epoprostenol

Antihypertensive Agents

Treatment Outcome

Infusions, Parenteral

Prospective Studies

Feasibility Studies

Time Factors

Middle Aged

Female

Male

Drug Substitution

Arterial Pressure

Pulmonary Arterial Hypertension

Experience in Transitioning From Parenteral Prostacyclins to Selexipag in Pulmonary Arterial Hypertension.

Journal article

Parikh, Kishan S|0000-0001-9996-8916

Rajagopal, Sudarshan|0000-0002-3443-5040

299

304

4

School of Medicine

Medicine, Cardiology

Duke

Medicine

Clinical Science Departments

Biochemistry

Basic Science Departments

Medicine, Pulmonary, Allergy, and Critical Care Medicine

Duke Clinical Research Institute

Institutes and Centers

Published

75