The Importance of Dose Escalation in the Treatment of Pulmonary Arterial Hypertension with Treprostinil
<b>Background</b>: Treprostinil, which is administered via continuous subcutaneous or intravenous infusion, is a medication applied in the treatment of pulmonary arterial hypertension (PAH). The dose of treprostinil is adjusted on an individual basis for each patient. A number of factors...
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2025-01-01
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| author | Piotr Kędzierski Marta Banaszkiewicz Michał Florczyk Michał Piłka Rafał Mańczak Maria Wieteska-Miłek Piotr Szwed Krzysztof Kasperowicz Katarzyna Wrona Szymon Darocha Adam Torbicki Marcin Kurzyna |
| author_facet | Piotr Kędzierski Marta Banaszkiewicz Michał Florczyk Michał Piłka Rafał Mańczak Maria Wieteska-Miłek Piotr Szwed Krzysztof Kasperowicz Katarzyna Wrona Szymon Darocha Adam Torbicki Marcin Kurzyna |
| author_sort | Piotr Kędzierski |
| collection | DOAJ |
| description | <b>Background</b>: Treprostinil, which is administered via continuous subcutaneous or intravenous infusion, is a medication applied in the treatment of pulmonary arterial hypertension (PAH). The dose of treprostinil is adjusted on an individual basis for each patient. A number of factors determine how well patients respond to treatment. <b>Objectives</b>: The aim of this study was to identify factors that may influence the clinical response to the dose of treprostinil at 3 months after the start of therapy. <b>Methods</b>: The factors influencing treatment response were analyzed in consecutive PAH patients who started receiving treprostinil treatment. The treatment efficacy was assessed as improvement in 6 min walk distance (6MWD) and WHO functional class (WHO FC), a reduction in N-terminal prohormone of brain natriuretic peptide (NTproBNP), and the percentage of patients achieving low-risk status after 12 months of treatment. <b>Results</b>: A total of 83 patients were included in this analysis. Classification of patients according to the tertiles of treprostinil dose achieved at 3 months after drug inclusion shows that after 12 months of follow-up, the median WHO FC in the highest dose group was lower than that in the intermediate dose group (WHO FC II vs. WHO FC III, <i>p</i> = 0.005), the median NTproBNP was lower (922 pg/mL, vs. 1686 pg/mL, <i>p</i> = 0.036) and 6MWD was longer (300 m vs. 510 m, <i>p</i> = 0.015). The French Noninvasive Criteria (NIFC) scale score was higher (2 vs. 0, <i>p</i> = 0.008), and the Reveal scale score was lower (5.0 vs. 8.5, <i>p</i> = 0.034). In the group of patients who exceeded a dose of 19.8 ng/kg/min within 3 months, an improvement in 6MWD was observed significantly more often after one year of therapy, and they were more likely to show an increase in NIFC scale scores after one year of therapy than the group of patients who received the lower dose (65% vs. 30%, <i>p</i> = 0.02). In the group of patients younger than 50 years of age, a statistically significant correlation was observed between the dose of treprostinil achieved after three months of treatment and the parameters assessed after 12 months of treatment, including WHO FC, 6MWD, and NIFC prognostic scale scores (all <i>p</i> < 0.05). <b>Conclusions</b>: The clinical effect of treatment is critically dependent on the rapid escalation of the treprostinil dose during the first three months of treatment. |
| format | Article |
| id | doaj-art-9e27bec7654f440cb57f922501b0ef12 |
| institution | Kabale University |
| issn | 2227-9059 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Biomedicines |
| spelling | doaj-art-9e27bec7654f440cb57f922501b0ef122025-01-24T13:24:15ZengMDPI AGBiomedicines2227-90592025-01-0113117210.3390/biomedicines13010172The Importance of Dose Escalation in the Treatment of Pulmonary Arterial Hypertension with TreprostinilPiotr Kędzierski0Marta Banaszkiewicz1Michał Florczyk2Michał Piłka3Rafał Mańczak4Maria Wieteska-Miłek5Piotr Szwed6Krzysztof Kasperowicz7Katarzyna Wrona8Szymon Darocha9Adam Torbicki10Marcin Kurzyna11Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, PolandChair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, PolandChair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, PolandChair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, PolandChair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, PolandChair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, PolandChair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, PolandChair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, PolandChair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, PolandChair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, PolandChair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, PolandChair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, ERN-LUNG Member, 05-400 Otwock, Poland<b>Background</b>: Treprostinil, which is administered via continuous subcutaneous or intravenous infusion, is a medication applied in the treatment of pulmonary arterial hypertension (PAH). The dose of treprostinil is adjusted on an individual basis for each patient. A number of factors determine how well patients respond to treatment. <b>Objectives</b>: The aim of this study was to identify factors that may influence the clinical response to the dose of treprostinil at 3 months after the start of therapy. <b>Methods</b>: The factors influencing treatment response were analyzed in consecutive PAH patients who started receiving treprostinil treatment. The treatment efficacy was assessed as improvement in 6 min walk distance (6MWD) and WHO functional class (WHO FC), a reduction in N-terminal prohormone of brain natriuretic peptide (NTproBNP), and the percentage of patients achieving low-risk status after 12 months of treatment. <b>Results</b>: A total of 83 patients were included in this analysis. Classification of patients according to the tertiles of treprostinil dose achieved at 3 months after drug inclusion shows that after 12 months of follow-up, the median WHO FC in the highest dose group was lower than that in the intermediate dose group (WHO FC II vs. WHO FC III, <i>p</i> = 0.005), the median NTproBNP was lower (922 pg/mL, vs. 1686 pg/mL, <i>p</i> = 0.036) and 6MWD was longer (300 m vs. 510 m, <i>p</i> = 0.015). The French Noninvasive Criteria (NIFC) scale score was higher (2 vs. 0, <i>p</i> = 0.008), and the Reveal scale score was lower (5.0 vs. 8.5, <i>p</i> = 0.034). In the group of patients who exceeded a dose of 19.8 ng/kg/min within 3 months, an improvement in 6MWD was observed significantly more often after one year of therapy, and they were more likely to show an increase in NIFC scale scores after one year of therapy than the group of patients who received the lower dose (65% vs. 30%, <i>p</i> = 0.02). In the group of patients younger than 50 years of age, a statistically significant correlation was observed between the dose of treprostinil achieved after three months of treatment and the parameters assessed after 12 months of treatment, including WHO FC, 6MWD, and NIFC prognostic scale scores (all <i>p</i> < 0.05). <b>Conclusions</b>: The clinical effect of treatment is critically dependent on the rapid escalation of the treprostinil dose during the first three months of treatment.https://www.mdpi.com/2227-9059/13/1/172pulmonary arterial hypertensionprostacyclintreprostinildose escalationrespond to treatment |
| spellingShingle | Piotr Kędzierski Marta Banaszkiewicz Michał Florczyk Michał Piłka Rafał Mańczak Maria Wieteska-Miłek Piotr Szwed Krzysztof Kasperowicz Katarzyna Wrona Szymon Darocha Adam Torbicki Marcin Kurzyna The Importance of Dose Escalation in the Treatment of Pulmonary Arterial Hypertension with Treprostinil Biomedicines pulmonary arterial hypertension prostacyclin treprostinil dose escalation respond to treatment |
| title | The Importance of Dose Escalation in the Treatment of Pulmonary Arterial Hypertension with Treprostinil |
| title_full | The Importance of Dose Escalation in the Treatment of Pulmonary Arterial Hypertension with Treprostinil |
| title_fullStr | The Importance of Dose Escalation in the Treatment of Pulmonary Arterial Hypertension with Treprostinil |
| title_full_unstemmed | The Importance of Dose Escalation in the Treatment of Pulmonary Arterial Hypertension with Treprostinil |
| title_short | The Importance of Dose Escalation in the Treatment of Pulmonary Arterial Hypertension with Treprostinil |
| title_sort | importance of dose escalation in the treatment of pulmonary arterial hypertension with treprostinil |
| topic | pulmonary arterial hypertension prostacyclin treprostinil dose escalation respond to treatment |
| url | https://www.mdpi.com/2227-9059/13/1/172 |
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