Pan Irene Z, Carey Jessica R, Jacobs Joshua A, Dechand John, Sessions Joshua J, Sorensen Teshia, Penn Brittany A, Mayeux Jennalyn D, Hatton Nathan D, Ryan John J
Department of Pharmacy, University of Utah Health, Salt Lake City, UT, United States.
Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, United States.
Front Med (Lausanne). 2020 Mar 31;7:81. doi: 10.3389/fmed.2020.00081. eCollection 2020.
New oral prostacyclin therapies and prostacyclin agonists have become available for the treatment of pulmonary arterial hypertension (PAH). However, methods for transitioning between oral, inhaled, and parenteral formulations are not well-established, except in the form of case reports and case series. Collectively, these emphasize the lack of a standardized process and approach in transitioning patients between PAH prostanoid therapies. In this case series, we report our experience at an accredited Pulmonary Hypertension center in transitioning between various oral, inhaled, and parenteral prostanoids to offer additional guidance on safe transitions in therapy. All cases of prostanoid transitions at an accredited Pulmonary Hypertension center from March 2018 to September 2019 were included in this report. The transition approach for each case was developed through a review of the literature, extrapolation of available pharmacokinetic data, and collaboration between pharmacists and clinicians. This case series describes the transition of 3 patients from selexipag to parenteral treprostinil; 1 patient transitioning from parenteral treprostinil to selexipag; 1 patient transitioning from oral treprostinil to parenteral treprostinil; and 1 patient transitioning from inhaled treprostinil to selexipag. Four of the 6 patients presented here were transitioned to an alternate prostanoid on account of clinical worsening, while the remaining 2 patients transitioned due to intolerance of parenteral therapy and poor medication adherence. This case series includes patients with various etiologies of PAH including idiopathic PAH, methamphetamine-associated PAH, and scleroderma-associated PAH. All patients successfully completed each transition without serious adverse events. With the increasing utilization and availability of prostanoids, there is a critical need for a standardized approach in transitioning safely between different formulations without compromising treatment efficacy. In this case series, we present our clinical experiences, guided by available pharmacokinetic data, in transitioning between various prostanoid formulations.
新型口服前列环素疗法和前列环素激动剂已可用于治疗肺动脉高压（PAH）。然而，除了病例报告和病例系列形式外，口服、吸入和肠胃外制剂之间的转换方法尚未得到充分确立。总体而言，这些都强调了在PAH类前列腺素疗法之间转换患者时缺乏标准化的流程和方法。在本病例系列中，我们报告了一家经认可的肺动脉高压中心在各种口服、吸入和肠胃外前列腺素之间转换的经验，以提供有关安全转换治疗的更多指导。本报告纳入了2018年3月至2019年9月在一家经认可的肺动脉高压中心发生的所有前列腺素转换病例。每个病例的转换方法是通过文献回顾、现有药代动力学数据的推断以及药剂师和临床医生之间的合作来制定的。本病例系列描述了3例患者从司来帕格转换为肠胃外曲前列尼尔；1例患者从肠胃外曲前列尼尔转换为司来帕格；1例患者从口服曲前列尼尔转换为肠胃外曲前列尼尔；以及1例患者从吸入曲前列尼尔转换为司来帕格。此处呈现的6例患者中有4例因临床病情恶化而转换为另一种前列腺素，而其余2例患者因肠胃外治疗不耐受和药物依从性差而转换。本病例系列包括患有各种PAH病因的患者，包括特发性PAH、甲基苯丙胺相关性PAH和硬皮病相关性PAH。所有患者均成功完成每次转换，未发生严重不良事件。随着前列腺素的使用和可及性不断增加，迫切需要一种标准化方法，以便在不影响治疗效果的情况下在不同制剂之间安全转换。在本病例系列中，我们介绍了在现有药代动力学数据指导下，在各种前列腺素制剂之间转换的临床经验。
