Chest
Original ResearchConversion to Bosentan From Prostacyclin Infusion Therapy in Pulmonary Arterial Hypertension: A Pilot Study
Section snippets
Patients
The study was approved by the institutional review boards at all five participating PAH centers (ie, Tufts-New England Medical Center, Boston Medical Center, Rhode Island Hospital/Brown University, Massachusetts General Hospital, and Temple University) and was overseen by a data safety monitoring board. Patients with PAH receiving therapy either epoprostenol or treprostinil by continuous infusion were offered entry into the trial for potential transitioning to therapy with oral bosentan, and
Demographics
Twenty-two PAH patients were recruited from a total of 72 patients with PAH who were receiving prostacyclin therapy at five PAH centers. The remaining 50 patients either declined study entry (16 patients) or were not deemed sufficiently stable (34 patients) for study entry. As shown in Table 1, all enrolled patients were women (age range, 23 to 75 years; mean age, 49 ± 3 years) and predominately white. Comorbid conditions, time from diagnosis, and duration of PGI2 therapy prior to study
Discussion
Our open-label, multicenter pilot study demonstrates that transitioning from therapy with prostacyclin infusion to bosentan is possible in a minority of PAH patients (10 of 22 patients; 45%). Late failures to transition necessitating the resumption of prostacyclin therapy reduced the number of patients who remained successfully transitioned after 12 months to 7 of 22 (32%). Although transition was considered successful if the patient continued not to receive IV therapy, the lower mean 6MWD at 1
Conclusions
Although transitioning from infusion to oral therapy greatly enhances convenience and is desirable from the patient's perspective, our findings indicate that such a transition from therapy with infused prostacyclins to bosentan therapy is possible only in a minority of patients. In general, patients who are likely to transition successfully are receiving lower prostacyclin doses and have relatively mild PA pressure elevation, both at the time of diagnosis and at the time of transition. Patients
ACKNOWLEDGMENT
The authors are grateful to Arlene Schiro, NP, Anne Marie Kuzma, and Barbara S. Smithson, RN BSN, for their assistance in preparing the article.
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
Drs. Steiner and Criner have reported to the ACCP that they have no significant conflicts of interest with any companies/organizations whose products or services may be discussed in this article. Dr. Preston has reported receiving grants from Actelion, Cotherix, Encysive, Myogen, Pfizer, United Therapeutics, and ICOS-Lilly. Dr. Klinger has reported receiving grants from Actelion, Cotherix, Encysive, Myogen, Pfizer, ICOS-Lilly, and Sanofi-Aventis. Dr. Waxman has reported receiving grants from Actelion, Cotherix, Encysive, Myogen, Pfizer, United Therapeutics, ICOS-Lilly, and Predix. Dr. Farber has reported receiving grants from Actelion, Cotherix, Encysive, Myogen, Pfizer, ICOS-Lilly, and Predix. Dr. Hill has reported the following conflicts of interest: he has worked for the speakers bureau of Actelion; and he has received research grants from Actelion, Cotherix, Encysive, Myogen, Pfizer, United Therapeutics, ICOS-Lilly, and Predix.
This research was supported by Actelion Pharmaceuticals US, Inc, Ipswich, MA.