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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Parikh, KS; Doerfler, S; Shelburne, N; Kennedy, K; Whitson, J; Dahhan, T; Fortin, T; Rajagopal, S

Published Date

  • April 2020

Published In

Volume / Issue

  • 75 / 4

Start / End Page

  • 299 - 304

PubMed ID

  • 31934912

Pubmed Central ID

  • 31934912

Electronic International Standard Serial Number (EISSN)

  • 1533-4023

Digital Object Identifier (DOI)

  • 10.1097/FJC.0000000000000800

Language

  • eng

Conference Location

  • United States