从静脉内依前列醇转换为肺动脉高压的口服或皮下治疗：回顾性病例系列和系统评价。
Transition from intravenous epoprostenol to oral or subcutaneous therapy in pulmonary arterial hypertension: a retrospective case series and systematic review.
机构信息
The Lung Center, Vancouver General Hospital, University of British Columbia.
出版信息
Can Respir J. 2011 May-Jun;18(3):157-62. doi: 10.1155/2011/104834.
BACKGROUND
Intravenous epoprostenol, a prostaglandin analogue, has been a mainstay of therapy for patients with advanced pulmonary arterial hypertension (PAH) since the early 1990s. This medication has multiple side effects, and sudden discontinuation is potentially associated with severe sequelae. Several recent case series have described the transition from intravenous to newer oral or subcutaneous therapies. A case series detailing the authors' experience with such transitions, and a systematic lierature review is presented.
METHODS
All consecutive PAH patients seen at the Vancouver Pulmonary Hypertension Clinic (Vancouver, British Columbia) between June 1995 and July 2009 were reviewed for cases in which weaning or transition from intravenous epoprostenol was attempted. The Cochrane Collaboration, Cochrane Register of Controlled Trials, Journals@Ovid, MEDLINE, EMBASE and Papers First were searched using predefined key words for publications describing transition of PAH patients from parenteral prostanoids to oral or subcutaneous agents.
RESULTS
Of the six patients who attempted, all transitioned successfully to oral or subcutaneous agents, having been on intravenous epoprostenol for a mean of 3.8 years (range 1.8 to 9.75 years). Five are living, surviving a mean of 5.5 years after transition. The literature search yielded nine studies and, of 127 patients described, 82 transitioned successfully. The length of pretransition prostanoid treatment (range 1.7 to 7.6 years) and the posttransition follow-up period (range two months to 70 months) were shorter than for patients described in the present study.
CONCLUSIONS
Given the rarity of PAH, the absolute numbers of patients transitioned from intravenous epoprostenol are still low. With the advent of new therapies, these numbers will hopefully increase; continued study is necessary to identify factors that are predictive of success.
背景
自 20 世纪 90 年代初以来，前列腺素类似物伊洛前列素静脉制剂一直是晚期肺动脉高压（PAH）患者的主要治疗药物。这种药物有多种副作用，突然停药可能会导致严重的后遗症。最近有几篇病例系列报道描述了从静脉制剂向新型口服或皮下制剂的过渡。本文介绍了作者在这方面的经验，并进行了系统的文献回顾。
方法
对 1995 年 6 月至 2009 年 7 月期间在温哥华肺高血压诊所就诊的所有连续 PAH 患者进行回顾性分析，以寻找尝试逐渐减少或停止伊洛前列素静脉制剂用量或过渡到其他治疗方案的病例。采用预定义的关键词，在 Cochrane 协作网、Cochrane 对照试验注册库、Ovid 期刊全文数据库、MEDLINE、EMBASE 和 Papers First 中检索描述 PAH 患者从肠外前列腺素类似物过渡到口服或皮下制剂的文献。
结果
在试图过渡的 6 例患者中，所有患者均成功过渡到口服或皮下制剂，使用伊洛前列素静脉制剂的平均时间为 3.8 年（1.8 至 9.75 年）。5 例患者存活，平均在过渡后生存 5.5 年。文献检索得到 9 项研究，127 例患者中 82 例成功过渡。与本研究中描述的患者相比，过渡前使用前列腺素类似物的时间（1.7 至 7.6 年）和过渡后的随访时间（2 个月至 70 个月）较短。
结论
由于 PAH 的罕见性，从伊洛前列素静脉制剂过渡的患者绝对数量仍然较少。随着新型治疗方法的出现，这一数字有望增加；需要进一步研究以确定预测成功的因素。
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