These authors contributed equally to this article.
Pulmonary Hypertension Program, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida, USA.
Pulm Circ. 2013 Dec;3(4):880-8. doi: 10.1086/674761.
Transition from prostacyclin analogue infusion to oral therapy in patients with pulmonary arterial hypertension (PAH) is possible with acceptable short- and midterm results. However, there is a paucity of data on long-term outcomes after successful transition. Using a predefined protocol, transition to oral therapy was attempted in 22 patients with clinically stable PAH. Clinical and hemodynamic data were retrospectively collected at baseline as well as during and after transition. Parameters for successful versus nonsuccessful transition were also evaluated. All patients had severe PAH at baseline and showed clinical and hemodynamic improvement with prostacyclin analogue infusion. Initial oral agents used for transition were bosentan (63.6%), sildenafil (31.8%), and tadalafil (4.5%). Combination therapy was used in 68% of the patients. Successful transition was achieved in 11 patients (50%) with a mean transition duration of 16 months. After successful transition, clinical and hemodynamic parameters remained stable at midterm (mean, 18 months) and long-term (mean, 60 months) follow-up. Compared with the successful transition group, patients who experienced failure were older, had a higher frequency of idiopathic PAH, and had worse hemodynamic parameters during treatment with prostacyclin analogue alone, as well as during the transition period. In conclusion, successful transition from prostacyclin analogue infusion to oral therapy can be achieved in a significant proportion of patients with clinically stable PAH. After an initial successful transition, patients were able to maintain clinical and hemodynamic stability at the mid- and long-term follow-up.
在肺动脉高压 (PAH) 患者中，从前列环素类似物输注转为口服治疗是可能的，且短期和中期结果可接受。然而，成功过渡后的长期结果数据有限。使用预先设定的方案，对 22 例临床稳定的 PAH 患者尝试了向口服治疗的过渡。在基线以及过渡期间和之后，回顾性地收集了临床和血流动力学数据。还评估了成功与不成功过渡的参数。所有患者在基线时均患有严重的 PAH，并且在使用前列环素类似物输注时显示出临床和血流动力学改善。用于过渡的初始口服药物为波生坦（63.6%）、西地那非（31.8%）和他达拉非（4.5%）。68%的患者使用联合治疗。11 例患者（50%）成功过渡，平均过渡时间为 16 个月。成功过渡后，在中期（平均 18 个月）和长期（平均 60 个月）随访时，临床和血流动力学参数保持稳定。与成功过渡组相比，过渡失败的患者年龄较大，特发性 PAH 发生率较高，单独使用前列环素类似物以及过渡期间的血流动力学参数更差。总之，在相当一部分临床稳定的 PAH 患者中，可以实现从前列环素类似物输注到口服治疗的成功过渡。在最初的成功过渡后，患者能够在中期和长期随访时保持临床和血流动力学的稳定。
