Long term experience with trerpostinil infusion treatment in patients with pulmonary arterial hypertension in the Czech Republic

Czech version

Authors: P. Jansa; D. Ambrož; J. Marešová; L. Jelínková; P. Poláček; T. Paleček; M. Aschermann; A. Linhart
Authors‘ workplace: Centrum pro plicní hypertenzi, vedoucí MUDr. Pavel Jansa, II. interní kliniky kardiologie a angiologie 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Aleš Linhart, DrSc.
Published in: Vnitř Lék 2007; 53(4): 333-337
Category: Original Contributions

Overview

Introduction:
Pulmonary arterial hypertension (PAH) is a serious primary illness of the pulmonary arterioles, characterised by progressive precapillary pulmonary hypertension. The conventional therapy for this condition is so-called specific pharmacotherapy, which addresses the key mechanisms in the pathophysiology of the illness, making use of drugs from the prostanoid group, endothelin receptor antagonists and phosphodiesterase inhibitors. Treprostinil is a stable analogue of prostacyclin, which can be administered subcutaneously, intravenously or by inhalation.

Patient sample and method:
In the centre for pulmonary hypertension in the Second Internal Clinic of Cardiology and Angiology of 1st Faculty of Medicine, Charles University, and the General Teaching Hospital in Prague, 22 patients with PAH (idiopathic PAH, familial PAH, PAH associated with congenital heart disease and PAH associated with systemic connective tissue disease) were treated with trerpostinil, 18 patients with a continuous subcutaneous infusion and 4 patients with a continuous intravenous infusion. The indicators followed were the distance reached in a 6-minute walking test, functional capacity assessed by NYHA classification and mortality.

Results:
The patients for whom treprostinil treatment was indicated had an average pressure in the right atrium of 11.9 ± 4.2 mm Hg, average pressure in the pulmonary artery of 56.8 ± ± 10.7 mm Hg, a cardiac index of 1.78 ± 0.25 l/min/m2 and a total pulmonary resistance of 16.26 ± 4.48 WU. 15 patients were functionally NYHA III and 7 patients were NYHA IV. The average distance achieved in a 6-minute walk test before the start of treatment was 326 ± 83 m. When treated with gradually increasing doses of treprostinil the distance achieved in the 6-minute walk test improved. After 6 months, the group that received subcutaneous treatment had extended their distance to 359 m, after 12 months it was 393 m, after 24 months 447 m and after 36 months 494 m. After 6 months, the group that received intravenous treatment had extended their distance to 473 m, which increased to 451 m after 12 months and 489 m after 24 months. Functional capacity also improved. In total 5 patients were unable to tolerate the subcutaneous infusion, of whom 3 were placed on intravenous treprostinil and 2 on oral bosentan. 7 of the patients died in the period examined (31.8%).

Conclusion:
Treprostinil improves symptoms and hemodynamics for PAH patients and reduces mortality.

Key words:
pulmonary arterial hypertension – pharmacotherapy – prostanoids – treprostinil

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