Am. J. Respir. Crit. Care Med., Volume 165, Number 6, March 2002, 800-804

Continuous Subcutaneous Infusion of Treprostinil, a Prostacyclin Analogue, in Patients with Pulmonary Arterial Hypertension
A Double-blind, Randomized, Placebo-controlled Trial

GERALD SIMONNEAU, ROBYN J. BARST, NAZZARENO GALIE, ROBERT NAEIJE, STUART RICH, ROBERT C. BOURGE, ANNE KEOGH, RONALD OUDIZ, ADAANI FROST, SHELMER D. BLACKBURN, JAMES W. CROW, and LEWIS J. RUBIN, for the Treprostinil Study Group

Division of Pulmonary and Critical Care Medicine, Antoine Béclère Hospital, Clamart, Paris-Sud University, Clamart, France; Department of Pediatrics, Columbia Presbyterian Medical Center, New York, New York; Division of Cardiology, University of Bologna, Bologna, Italy; Departments of Pathophysiology and Cardiac Surgery, Erasme University Hospital, Brussels, Belgium; Division of Cardiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois; Division of Cardiology, University of Alabama, Birmingham, Alabama; Department of Medicine, St. Vincent's Hospital, Sydney, Australia; Division of Cardiology, Harbor-UCLA Medical Center, Torrance, California; Pulmonary Section, Lung Transplant Program, Baylor College of Medicine, Houston, Texas; United Therapeutic Corporation, Research Triangle Park, North Carolina; and Division of Pulmonary and Critical Care Medicine, University of California, San Diego, California

Pulmonary arterial hypertension is a life-threatening disease for which continuous intravenous prostacyclin has proven to be effective. However, this treatment requires a permanent central venous catheter with the associated risk of serious complications such as sepsis, thromboembolism, or syncope. Treprostinil, a stable prostacyclin analogue, can be administered by a continuous subcutaneous infusion, avoiding these risks. We conducted a 12-week, double-blind, placebo-controlled multicenter trial in 470 patients with pulmonary arterial hypertension, either primary or associated with connective tissue disease or congenital systemic-to-pulmonary shunts. Exercise capacity improved with treprostinil and was unchanged with placebo; the between treatment group difference in median six-minute walking distance was 16 m (p = 0.006). Improvement in exercise capacity was greater in the sicker patients and was dose-related, but independent of disease etiology. Concomitantly, treprostinil significantly improved indices of dyspnea, signs and symptoms of pulmonary hypertension, and hemodynamics. The most common side effect attributed to treprostinil was infusion site pain (85%) leading to premature discontinuation from the study in 8% of patients. Three patients in the treprostinil treatment group presented with an episode of gastrointestinal hemorrhage. We conclude that chronic subcutaneous infusion of treprostinil is an effective treatment with an acceptable safety profile in patients with pulmonary arterial hypertension.

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				S. I. Said Mediators and modulators of pulmonary arterial hypertension Am J Physiol Lung Cell Mol Physiol, October 1, 2006; 291(4): L547 - L558. [Abstract] [Full Text] [PDF]

				H. A. Ghofrani, R. Voswinckel, F. Reichenberger, N. Weissmann, R. T. Schermuly, W. Seeger, and F. Grimminger Hypoxia- and non-hypoxia-related pulmonary hypertension - Established and new therapies Cardiovasc Res, October 1, 2006; 72(1): 30 - 40. [Abstract] [Full Text] [PDF]

				V. V. McLaughlin and M. D. McGoon Pulmonary Arterial Hypertension Circulation, September 26, 2006; 114(13): 1417 - 1431. [Full Text] [PDF]

				O. Sanchez, O. Sitbon, X. Jais, G. Simonneau, and M. Humbert Immunosuppressive therapy in connective tissue diseases-associated pulmonary arterial hypertension. Chest, July 1, 2006; 130(1): 182 - 189. [Abstract] [Full Text] [PDF]

				M H Williams, C Das, C E Handler, M R Akram, J Davar, C P Denton, C J Smith, C M Black, and J G Coghlan Systemic sclerosis associated pulmonary hypertension: improved survival in the current era Heart, July 1, 2006; 92(7): 926 - 932. [Abstract] [Full Text] [PDF]

				T. Adriaenssens, M. Delcroix, K. Van Deyk, and W. Budts Advanced therapy may delay the need for transplantation in patients with the Eisenmenger syndrome Eur. Heart J., June 2, 2006; 27(12): 1472 - 1477. [Abstract] [Full Text] [PDF]

				R. L. Benza, B. K. Rayburn, J. A. Tallaj, C. S. Coffey, L. J. Pinderski, S. V. Pamoukian, and R. C. Bourge Efficacy of bosentan in a small cohort of adult patients with pulmonary arterial hypertension related to congenital heart disease. Chest, April 1, 2006; 129(4): 1009 - 1015. [Abstract] [Full Text] [PDF]

				I. M. Robbins, S. M. Kawut, D. Yung, M. P. Reilly, W. Lloyd, G. Cunningham, J. Loscalzo, S. E. Kimmel, B. W. Christman, and R. J. Barst A study of aspirin and clopidogrel in idiopathic pulmonary arterial hypertension. Eur. Respir. J., March 1, 2006; 27(3): 578 - 584. [Abstract] [Full Text] [PDF]

				V. F. Tapson, M. Gomberg-Maitland, V. V. McLaughlin, R. L. Benza, A. C. Widlitz, A. Krichman, and R. J. Barst Safety and Efficacy of IV Treprostinil for Pulmonary Arterial Hypertension: A Prospective, Multicenter, Open-Label, 12-Week Trial Chest, March 1, 2006; 129(3): 683 - 688. [Abstract] [Full Text] [PDF]

				V. V. McLaughlin 'Raising the bar' for the treatment of pulmonary arterial hypertension Eur. Heart J., March 1, 2006; 27(5): 510 - 511. [Full Text] [PDF]

				C A Elliot and D G Kiely Pulmonary hypertension CEACCP, February 1, 2006; 6(1): 17 - 22. [Full Text] [PDF]

				R. Voswinckel, H. A. Ghofrani, F. Grimminger, W. Seeger, and H. Olschewski Inhaled Treprostinil for Treatment of Chronic Pulmonary Arterial Hypertension Ann Intern Med, January 17, 2006; 144(2): 149 - 150. [Full Text] [PDF]

				B. Fernandez and D. Strootman The Prostacyclin Analog, Treprostinil Sodium, Provides Symptom Relief in Severe Buerger's Disease: A Case Report and Review of Literature Angiology, January 1, 2006; 57(1): 99 - 102. [Abstract] [PDF]

				L. J. Rubin Pulmonary arterial hypertension. Proceedings of the ATS, January 1, 2006; 3(1): 111 - 115. [Abstract] [Full Text] [PDF]