Adults who have pulmonary arterial hypertension (PAH) may safely transition from infusion therapy to an oral medication by following a rapid dose-titration approach during a monitored hospital stay. That’s according to the paper, “Transitions From Parenteral Prostacyclin Analogues to Selexipag in Patients With Pulmonary Arterial Hypertension,” published in Pulmonary Circulation.
Researchers of the study reported positive outcomes of 35 adult patients with PAH who switched from intravenous epoprostenol (54%) or subcutaneous treprostinil (34%) to oral selexipag during hospitalizations at the University of Cincinnati Medical Center in Ohio.
All three treatments are prostacyclin pathway agents (PPAs) that are approved by the U.S. Food and Drug Administration (FDA) to reduce blood pressure and widen blood vessels in the lungs of adult patients with PAH. Epoprostenol and treprostinil are administered via infusion into the bloodstream which can be burdensome and too invasive for some patients. Since selexipag is administered orally, it can be a helpful alternative for patients who need or want to stop parenteral PPAs, the researchers said.
“Parenteral PPAs are continuous infusion medications that are complicated to use and can be associated with bloodstream infections if administered intravenously or with infusion site pain if administered subcutaneously. Consequently, patients on these therapies frequently require or request transition to an oral prostacyclin pathway agent,” the authors wrote.
However, stopping and starting medications can carry safety risks, and there is limited research supporting a specific approach, they added.
“There is very little published data on transitioning from parenteral PPAs to selexipag, and questions remain about the optimal approach to transition,” the authors wrote. “This study aimed to describe processes and outcomes associated with inpatient transitions from parenteral to oral selexipag in a small, single-center cohort of PAH patients.”
According to the study, the evaluated transition protocol centered on overlapping the two treatments to avoid an abrupt withdrawal of the infusion therapy. This involved gradually decreasing the dose of the parenteral PPA while simultaneously increasing the selexipag oral dosage. While doses were personalized to each patient, clinicians followed a standardized transition strategy, the researchers said, which took an average 36 hours to rapidly complete.
The inpatient transitions were mostly planned versus unplanned (77% and 23%, respectively), and the primary reasons for switching therapeutic approaches were infusion site problems, intravenous access issues or caregiver-related difficulties, the researchers reported.
Following the transition, researchers observed stable PAH risk scores and functional status, which measures the extent that PAH symptoms limit a person’s daily activities. Patient outcomes were similar whether the transition was planned or unplanned, they noted.
“In summary, rapid transition from a parenteral PPA to selexipag can be performed in a safe and effective way for patients in a hospitalized setting with careful monitoring,” the authors wrote.
The study provides helpful guidance for clinicians who are transitioning patients, the researchers said, but results were limited by the small, single-center population, and additional research would further validate the findings.
“Future research to evaluate candidacy for transition, tolerance of transition and a protocolized approach to dosage selections are needed to further optimize the transition approach to patients on parenteral PPAs,” the authors concluded.
