Pneumologie 2020; 74(S 01): 125
DOI: 10.1055/s-0039-3403348
Freie Vorträge (FV13) – Sektion Kardiorespiratorische Interaktion
Freie Vorträge der Sektion Kardiorespiratorische Interaktion
Georg Thieme Verlag KG Stuttgart · New York

Long-term safety and outcome of subcutaneous and intravenous treprostinil treatment in patients with severe chronic pulmonary hypertension

S Harutyunova
1   Centre for Pulmonary Hypertension, Thoraxklinik at University Hopspital Hospital, Translational Lung Research Center Heidelberg (Tlrc), Member of German Center of Lung Research (Dzl),Heidelberg Germany
,
N Benjamin
1   Centre for Pulmonary Hypertension, Thoraxklinik at University Hopspital Hospital, Translational Lung Research Center Heidelberg (Tlrc), Member of German Center of Lung Research (Dzl),Heidelberg Germany
,
C Eichstaedt
2   Zentrum für Pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg, Translational Lung Research Centre Heidelberg (Tlrc), German Centre for Lung Research (Dzl), Institut für Humangenetik, Universität Heidelberg
,
AM Marra
3   Centre for Pulmonary Hypertension at the Thoraxclinic, University Hospital Heidelberg, Translational Lung Research Center Heidelberg (Tlrc), Member of the German Center for Lung Research (Dzl), Heidelberg, Germany; Irccs Sdn, Naples Italy
,
P Xanthouli
1   Centre for Pulmonary Hypertension, Thoraxklinik at University Hopspital Hospital, Translational Lung Research Center Heidelberg (Tlrc), Member of German Center of Lung Research (Dzl),Heidelberg Germany
,
B Egenlauf
4   Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg; Zentrum für Pulmonale Hypertonie, Thoraxklinik Universitätsklinik Heidelberg
,
E Grünig
1   Centre for Pulmonary Hypertension, Thoraxklinik at University Hopspital Hospital, Translational Lung Research Center Heidelberg (Tlrc), Member of German Center of Lung Research (Dzl),Heidelberg Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
28. Februar 2020 (online)

Auch verfügbar auf
 
 

    Background: The objective of this study was to analyse safety, clinical effects and long-term outcomes of s. c. and/or i. v. treprostinil administered via Crono and implantable LENUS Pro pump in consecutive patients with severe PAH.

    Methods: Thirty-seven PAH patients (20 females, mean age 51 ± 15 years, mean pulmonary arterial pressure at diagnosis 62.3 ± 14.4 mmHg, cardiac index 2.4 ± 0.7 L/min/m2, pulmonary vascular resistance 938 ± 351.7dyn×sec×cm−5, WHO functional class 6 II, 26 III, 5 IV) who were on triple PAH medication (ERA, PDE5 inhibitors and treprostinil s. c./i. v.) were clinically assessed every 3 months ([Fig. 1]). Survival rate was analysed using Kaplan Meier estimation.

    Zoom Image
    Fig. 1 Study flow-chart of 37 patients treated with sc. treprostinil.

    Results: Patients showed a significant improvement of 6-minute walking distance after 3 (p = 0.021), 6 (p = 0.033) and 12 months (p = 0.042) of s. c. treprostinil treatment. Furthermore, tricuspid annular plane systolic excursion, right atrial and right ventricular area improved after 3 and 6 months s. c. treatment compared to baseline (all p < 0.05). After a mean therapy with treprostinil s. c. of 6 ± 0.9 months, in 24 patients a Lenus Pro pump was implanted for i. v. administration of treprostinil. Two pumps required surgical revision after 1.5 ± 1 months, four further pumps had to be explanted after 11 ± 12 months (due to infection n = 2, catheter occlusion n = 1, tear off of catheter n = 1). During a mean follow-up of 2.82 ± 1.95 years in all patients, 12 patients died, three patients received lung transplantation. Transplant-free survival after 1 year was 85.7%, after 2 years 69.2% and after 3 years 65.3%.

    Conclusion: S. c. treprostinil as add-on to double combination treatment significantly improved right heart size and function in PAH. In most patients treprostinil could be continued via implanted Lenus Pro pump and showed in view of the severe disease a reasonable overall-survival.


    #
     
    Zoom Image
    Fig. 1 Study flow-chart of 37 patients treated with sc. treprostinil.