PAH: Implantable Treprostinil Delivery System Is Promising

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The intravascular delivery system resulted in patients spending approximately 75% less time managing therapy delivery vs previous treatment.
The intravascular delivery system resulted in patients spending approximately 75% less time managing therapy delivery vs previous treatment.

A fully implantable programmable intravascular delivery system using treprostinil, a prostacyclin derivative, is highly stable and provides an acceptable satisfactory profile in severely ill patients with pulmonary arterial hypertension (PAH), according to an editorial published in Chest.1

Intravenous epoprostenol, a current therapeutic option for severely ill patients with PAH, presents some clinical challenges. First, the therapy requires an alkaline pH to maintain stability. In addition, it has a short half-life of 3 to 5 minutes and must be delivered via continuous intravenous infusion.

A new prostacyclin derivative, treprostinil, provides a more favorable profile in terms of a longer half-life (4.4 to 4.6 hours) and greater stability at room temperature than epoprostenol. It can also be delivered intravenously via continuous infusion, subcutaneously, by inhalation (4 times daily), or orally (2 to 4 times daily).

Side effects such as cough, diarrhea, headache, nausea, and jaw pain have limited the widespread application of treprostinil across the entire PAH patient population. Also, many patients need higher doses of treprostinil to control their PAH.

The investigators cited the DelIVery for Pulmonary Arterial Hypertension (DelIVery; ClinicalTrials.gov identifier: NCT01321073) trial, which evaluated the feasibility of a fully implantable treprostinil delivery system using a drug infusion pump in patients with PAH.2 According to the findings, the system resulted in patients spending approximately 75% less time managing therapy delivery vs previous treatment.

According to the investigators, successful implantation of such a system relies on patient education as well as the operator's level of experience and technical skill.

Overall, the investigators suggested a “planned staged approach of transitioning patients with PAH from [intravenous] therapy to a less complex system could lend itself to using prostanoids earlier and for less severely affected patients with PAH.”

References

  1. Wirth JA, Palevsky HI. Prostacyclin therapy for pulmonary arterial hypertension evolves again with the development of an implantable delivery system. Chest. 2017;152(6):1100-1102.
  2. Bourge RC, Waxman AB, Gomberg-Maitland M, et al. Treprostinil administered to treat pulmonary arterial hypertension using a fully implantable programmable intravascular delivery system: results of the DelIVery for PAH trial. Chest. 2016;150(1):27-34. 

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