PMID- 18022071
OWN - NLM
STAT- MEDLINE
DCOM- 20080311
LR  - 20171116
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 26
IP  - 11
DP  - 2007 Nov
TI  - Safety and efficacy of transition from subcutaneous treprostinil to oral 
      sildenafil in patients with pulmonary arterial hypertension.
PG  - 1079-83
AB  - BACKGROUND: Sildenafil is a selective inhibitor of phosphodiesterase type 5 
      (PDE5), and has been shown to improve 6-minute walk distance (SMWD) and World 
      Health Organization (WHO) functional class in patients with idiopathic pulmonary 
      arterial hypertension (iPAH) and PAH associated with connective tissue disease or 
      with repaired congenital systemic-to-pulmonary shunts. Despite the efficacy of 
      sildenafil in patients on conventional therapy with diuretics and 
      anti-coagulants, little is known of the safety and efficacy of transitioning 
      patients already established on parenteral prostanoid therapy to sildenafil. 
      METHODS: We studied 14 patients on long-term subcutaneous treprostinil for PAH 
      (from a cohort of 51 patients [27%]), who wished to discontinue treatment because 
      of injection-site pain. The etiology of their PAH included iPAH (7 of 14), PAH 
      secondary to scleroderma (2 of 14), thromboembolic disease (3 of 14) and PAH 
      post-surgical correction of ventricular septal defect (2 of 14). Treprostinil was 
      gradually weaned and all patients were started open-label with 50 mg sildenafil 
      four times per day for 3 months. New York Heart Association (NYHA) functional 
      class, SMWD, echocardiogram and quality-of-life (QOL) measures were determined at 
      baseline and after 3 months of therapy with sildenafil. RESULTS: Of 14 patients, 
      4 discontinued the transition because of deterioration during treprostinil 
      withdrawal, despite the introduction of sildenafil. Replacement of chronic 
      subcutaneous treprostinil with sildenafil was possible in 10 of 14 patients 
      (71%), who demonstrated stable NYHA class (mean +/- SD: 3.1 +/- 0.3 at baseline 
      to 2.6 +/- 0.8 at 3 months, p = 0.138), stable SMWD (434 +/- 83 m at baseline, 
      451 +/- 72 at 3 months, p = 0.23) and significantly improved QOL measures at 3 
      months. CONCLUSIONS: The transition from subcutaneous treprostinil to sildenafil 
      was safely achieved in most (71%), but not all, patients with pulmonary arterial 
      hypertension of varied etiology. These patients had an improvement in both NYHA 
      functional class and QOL, and maintained stable walk distances over a 3-month 
      period on sildenafil therapy.
FAU - Keogh, Anne M
AU  - Keogh AM
AD  - Heart Lung Transplant Unit, St Vincent's Hospital, Sydney, Australia.
FAU - Jabbour, Andrew
AU  - Jabbour A
FAU - Weintraub, Robert
AU  - Weintraub R
FAU - Brown, Karen
AU  - Brown K
FAU - Hayward, Chris S
AU  - Hayward CS
FAU - Macdonald, Peter S
AU  - Macdonald PS
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20071024
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
RN  - 0 (Antihypertensive Agents)
RN  - 0 (Piperazines)
RN  - 0 (Purines)
RN  - 0 (Sulfones)
RN  - 0 (Vasodilator Agents)
RN  - BW9B0ZE037 (Sildenafil Citrate)
RN  - DCR9Z582X0 (Epoprostenol)
RN  - RUM6K67ESG (treprostinil)
SB  - IM
MH  - Administration, Oral
MH  - Adult
MH  - Antihypertensive Agents/administration & dosage/adverse effects/*therapeutic use
MH  - Drug-Related Side Effects and Adverse Reactions
MH  - Epoprostenol/administration & dosage/adverse effects/*analogs & 
      derivatives/therapeutic use
MH  - Exercise Tolerance
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/*drug therapy/etiology/physiopathology
MH  - Injections, Subcutaneous
MH  - Male
MH  - Middle Aged
MH  - Piperazines/administration & dosage/adverse effects/*therapeutic use
MH  - Purines/administration & dosage/adverse effects/therapeutic use
MH  - Quality of Life
MH  - Sildenafil Citrate
MH  - Sulfones/administration & dosage/adverse effects/*therapeutic use
MH  - Vasodilator Agents/administration & dosage/adverse effects/*therapeutic use
EDAT- 2007/11/21 09:00
MHDA- 2008/03/12 09:00
CRDT- 2007/11/21 09:00
PHST- 2007/04/23 00:00 [received]
PHST- 2007/07/23 00:00 [revised]
PHST- 2007/07/27 00:00 [accepted]
PHST- 2007/11/21 09:00 [pubmed]
PHST- 2008/03/12 09:00 [medline]
PHST- 2007/11/21 09:00 [entrez]
AID - S1053-2498(07)00602-X [pii]
AID - 10.1016/j.healun.2007.07.040 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2007 Nov;26(11):1079-83. doi: 
      10.1016/j.healun.2007.07.040. Epub 2007 Oct 24.