Oral Treprostinil Dosing Characteristics in Pulmonary Arterial Hypertension

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Higher frequency dosing of oral treprostinil correlated with both increased total daily dosing and dose acceleration rate.
Higher frequency dosing of oral treprostinil correlated with both increased total daily dosing and dose acceleration rate.

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

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