The following is a summary of “Parenteral treprostinil induction for rapid attainment of therapeutic doses of oral treprostinil,” published in the NOVEMBER 2023 issue of Pulmonology by Miller, et al.

Oral treprostinil has demonstrated its efficacy in slowing the progression of pulmonary arterial hypertension (PAH) and improving exercise capacity. However, the titration process for this medication can be lengthy. Existing data indicated that patients who have not previously received prostacyclin therapy achieve a total daily oral treprostinil dose of approximately 6 mg by Week 16. In contrast, those previously on parenteral treprostinil reached higher doses simultaneously. For the EXPEDITE study, a single-arm, multicenter investigation, researchers sought to evaluate the effectiveness of rapidly introducing parenteral treprostinil to expedite the attainment of higher oral treprostinil doses for treating pulmonary arterial hypertension.

Patients underwent titration of parenteral treprostinil for a period ranging from 2 to 8 weeks, followed by the concurrent titration of oral treprostinil. The primary endpoint was the percentage of patients achieving a daily oral treprostinil dose of ≥12 mg by Week 16. Secondary endpoints encompassed assessing clinical changes from baseline to Week 16.

The efficacy analysis involved 29 prostacyclin-naïve patients. By Week 16, the mean daily oral treprostinil dose reached 16.4 mg, with 79% of patients meeting the primary endpoint. Over this period, there was a noteworthy improvement in the median REVEAL Lite 2 score, which decreased from 6 to 3.5 (P = 0.0006). Significant enhancements were also observed in various parameters, including World Health Organization Functional Class, N-terminal-pro brain natriuretic peptide levels, 6-minute walk distance, right atrial area, Borg Dyspnea Score, and emPHasis-10 score. Additionally, favorable trends were noted in risk stratification, echocardiography measures, disease symptoms, and treatment satisfaction.

A brief parenteral treprostinil induction regimen resulted in oral treprostinil doses that were more than double those reported for de novo initiations. The approach held promise to achieve oral treprostinil’s therapeutic benefits rapidly.

Source: resmedjournal.com/article/S0954-6111(23)00262-7/fulltext