Oral Treprostinil Dosing Characteristics in Pulmonary Arterial Hypertension

In clinical practice, patients with pulmonary arterial hypertension (PAH) are prescribed oral treprostinil at a frequency of either 2 or 3 times per day, but prescribers favor a frequency of 3 times a day, according to a recent study published in Pulmonary Circulation.

Medication shipping records from specialty pharmacy services were obtained for patients (n=1600) receiving oral treprostinil. Patients were separated into 4 categories according to medication history, and data were compared within groups. The 4 groups were 3 times per day de novo (n=758), 3 times per day transition (n=442), 2 times per day de novo (n=320), and 2 times per day transition (n=80). Patients in the transition groups had previously received treprostinil subcutaneously, intravenously, or by inhalation.

Of the patients who received oral treprostinil, 1200 were administered the medication at a frequency of 3 times per day. Higher-frequency dosing also correlated with both increased total daily dosing and dose acceleration rate during the 18-month titration period when the 2 de novo groups were compared. Overall, the highest total daily dose was achieved in the 3 times per day transition group, followed by the 3 times per day -de novo group, the 2 times per day transition group, and the 2 times per day de novo group.

The study authors wrote, “We speculate the more prevalent use of [3 times per day] dosing and the ability to reach higher [total daily doses] may reflect an improved tolerability profile as compared with [2 times per day] dosing.”

They also noted a possible mechanism for the increased incidence of higher frequency dosing among providers, suggesting, “a more stable plasma concentration may reduce the frequency and severity of adverse events, facilitating dose up-titration.”

Reference

Balasubramanian V, Messick CR, Broderick M, Nelson AC. Dosing characteristics of oral treprostinil in real-world clinical practice [published online March 27, 2018]. Pulm Circ. doi:10.1177/2045894018770654