Department of Internal Medicine B, University Hospital Greifswald, Greifswald, Germany.
Department of Cardiology, DRK Kliniken Berlin and Charité - Universitätsmedizin Berlin, Berlin, Germany.
Respir Med. 2021 Apr;179:106336. doi: 10.1016/j.rmed.2021.106336. Epub 2021 Feb 16.
Therapy with intravenous prostacyclin analogues in patients with pulmonary arterial hypertension (PAH) has been established for decades and is an integral component of the current guidelines for the treatment of pulmonary hypertension. Initially, these drugs were infused by external pump systems via tunnelled right atrial catheters with the need for cooling and frequent exchange of drug reservoirs. Associated complications included, among others, catheter-related infections. More recently, fully implantable pump systems have been developed with drug reservoirs that are filled transcutaneously, allowing intervals between refills of several weeks. This technique results in a low rate of infections. Epoprostenol, iloprost and treprostinil have all been used intravenously in PAH, but titration, dosing and dose escalation in long-term therapy are not standardized. Intravenous prostacyclin analogues are still under-used, despite available data suggesting that early and broad application of these therapies as part of risk-oriented, guideline-directed combination therapy for patients with PAH may lead to a survival benefit. This review provides a detailed overview of the drugs, infusion systems and dosing strategies used for intravenous therapy in patients with PAH.
静脉注射前列环素类似物治疗肺动脉高压 (PAH) 已数十年，是当前肺动脉高压治疗指南的重要组成部分。最初，这些药物通过带隧道的右心房导管使用外部泵系统输注，需要冷却和频繁更换药物储库。相关并发症包括导管相关感染等。最近，已经开发出完全可植入的泵系统，其药物储库可经皮填充，允许每隔数周进行一次补液。该技术可降低感染率。依前列醇、伊洛前列素和曲前列尼尔均已在 PAH 患者中静脉使用，但在长期治疗中，滴定、剂量和剂量递增尚未标准化。尽管有数据表明，将这些治疗方法作为基于风险的、指南指导的 PAH 患者联合治疗的一部分早期广泛应用可能带来生存获益，但静脉注射前列环素类似物的应用仍不足。本文详细综述了用于 PAH 患者静脉治疗的药物、输注系统和剂量策略。
