Clinical utility of treprostinil in the treatment of pulmonary arterial hypertension: an evidence-based review

Pulmonary arterial hypertension (PAH) remains a progressive disease without a cure, despite the development of several treatment options over the past several decades. Its management strategy consists of the endothelin receptor antagonists (ambrisentan, bosentan, macitentan), phosphodiesterase-5 inh...

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Bibliographic Details
Published in:Core evidence 2014-01, Vol.9, p.71-80
Main Authors: Buckley, Mitchell S, Berry, Andrew J, Kazem, Nadine H, Patel, Shardool A, Librodo, Paul A
Format: Article
Language:English
Subjects:
Bioavailability
Cardiology
Clinical trials
Drug dosages
Heart
Pathogenesis
Patients
Pharmacy
prostacyclin
pulmonary arterial hypertension
Pulmonary arteries
Pulmonary hypertension
Quality of life
Review
Smooth muscle
treprostinil
Veins & arteries
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Summary:Pulmonary arterial hypertension (PAH) remains a progressive disease without a cure, despite the development of several treatment options over the past several decades. Its management strategy consists of the endothelin receptor antagonists (ambrisentan, bosentan, macitentan), phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil), and prostacyclin analogs (epoprostenol, treprostinil, iloprost). Treprostinil, a stable prostacyclin analog, displays vasodilatory effects in the pulmonary vasculature, as well as antiplatelet aggregation properties. Clinical practice guidelines recommend oral endothelin receptor antagonist or phosphodiesterase inhibitor therapy in mild to moderate PAH. Epoprostenol is specifically suggested as first-line therapy in moderate to severe PAH patients (ie, World Health Organization/New York Heart Association functional class III-IV). However, treprostinil may be an alternative option in these severe PAH patients. The longer half-life and stability at room temperature with treprostinil may be associated with lower risk of pulmonary hemodynamic worsening as a result of abrupt infusion discontinuation and less frequent drug preparation. These characteristics make treprostinil an attractive alternative to continuous infusion of epoprostenol, due to convenience and patient safety. The purpose of this review is to evaluate the safety and efficacy of continuous infusion of treprostinil as well as the inhaled and oral routes of administration in PAH.
ISSN:1555-1741
1555-175X
1555-175X
DOI:10.2147/CE.S50607