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, Lewis J. Rubin

Research output: Contribution to journalArticle

1140 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)800-804
Number of pages5
JournalAmerican journal of respiratory and critical care medicine
Volume165
Issue number6
DOIs
StatePublished - Mar 15 2002

Keywords

  • Primary pulmonary hypertension
  • Prostacyclin analogue
  • Pulmonary arterial hypertension associated with congenital systemic-to-pulmonary shunts
  • Pulmonary arterial hypertension associated with connective tissue disease
  • Treprostinil

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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