Practical management of oral treprostinil in patients with pulmonary arterial hypertension: Lessons from ADAPT, EXPEDITE, and expert consensus

Oral treprostinil is a prostacyclin analogue approved to treat pulmonary arterial hypertension (PAH) by delaying disease progression and improving exercise capacity. Higher doses of oral treprostinil correlate with increased treatment benefit. Titrations may be challenging due to common side effects...

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Bibliographic Details
Published in:Respiratory medicine 2024-09, Vol.231, p.107734, Article 107734
Main Authors: Brewer, Jacqueline, Wilson, Melisa, Coons, James C., Schmit, Ann, Whittenhall, Mary E., Kimber, Amy, Broderick, Meredith, Lee, Dasom, Patzlaff, Natalie, Miller, Chad, Ataya, Ali, LaRoy, Valerie, King, Christopher S., Ravichandran, Ashwin K., Kingrey, John F., Sahay, Sandeep
Format: Article
Language:English
Subjects:
Dosing
Orenitram
Patient selection
Prostacyclin
Pulmonary arterial hypertension
Side effects
Tolerability
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Summary:Oral treprostinil is a prostacyclin analogue approved to treat pulmonary arterial hypertension (PAH) by delaying disease progression and improving exercise capacity. Higher doses of oral treprostinil correlate with increased treatment benefit. Titrations may be challenging due to common side effects of prostacyclin-class therapies. The multicenter, prospective, real-world, observational ADAPT Registry study followed adult patients with PAH for up to 78 weeks after initiating oral treprostinil (NCT03045029). Dosing, titration, and transitions of oral treprostinil were at the discretion of the prescriber. Patient-reported incidence and treatment of common side effects were collected to understand side effect management and tolerability. Insights from literature and expert recommendations were added to provide a consolidated resource for oral treprostinil use. In total, 139 participants in ADAPT completed ≥1 weekly survey; (median age 60.0 years, 76 % female). Median treatment duration of oral treprostinil was 13.1 months. During early therapy (Months 1–5), 62 % (78/126) of patients reported headache and diarrhea, and 40 % (50/126) reported nausea. At Month 6, many patients who reported side effects during early therapy reported an improvement (61 % headache, 44 % diarrhea, 70 % nausea). Common side effect treatments, including acetaminophen, loperamide, and ondansetron, were effective. Approximately one-quarter of patients reporting the most common side effects were untreated at Month 6. Patient selection for, and initiation and titration of, oral treprostinil should be individualized and may include parenteral treprostinil induction-transition for faster titration. Assertive side effect management may help patients reach higher and more efficacious doses of oral treprostinil. [Display omitted] •Oral treprostinil can be initiated de novo, by transition, or induction-transition.•Patients may benefit from side effect support during initiation and up-titration.•Common side effect treatments were reported by patients to be effective.•PAH treatment and side effects strategy need to be individualized for each patient.
ISSN:0954-6111
1532-3064
1532-3064
DOI:10.1016/j.rmed.2024.107734