Efficacy and safety of oral treprostinil monotherapy for the treatment of pulmonary arterial hypertension: A randomized, controlled trial

Zhi Cheng Jing, Keyur Parikh, Tomas Pulido, Carlos Jerjes-Sanchez, R. James White, Roblee P Allen, Adam Torbicki, Kai Feng Xu, David Yehle, Kevin Laliberte, Carl Arneson, Lewis J. Rubin

Research output: Contribution to journalArticle

197 Citations (Scopus)

Abstract

BACKGROUND-: Pulmonary arterial hypertension (PAH) is a progressive, fatal disease with no cure. Parenteral and inhaled prostacyclin analogue therapies are effective for the treatment of PAH, but complicated administration requirements can limit the use of these therapies in patients with less severe disease. This study was designed to evaluate the safety and efficacy of the oral prostacyclin analogue treprostinil diolamine as initial treatment for de novo PAH. METHODS AND RESULTS-: Three hundred forty-nine patients (intent-to-treat population) not receiving endothelin receptor antagonist or phosphodiesterase type-5 inhibitor background therapy were randomized (treprostinil, n=233; placebo, n=116). The primary analysis population (modified intent-to-treat) included 228 patients (treprostinil, n=151; placebo, n=77) with access to 0.25-mg treprostinil tablets at randomization. The primary end point was change from baseline in 6-minute walk distance at week 12. Secondary end points included Borg dyspnea index, clinical worsening, and symptoms of PAH. The week 12 treatment effect for 6-minute walk distance (modified intent-to-treat population) was 23.0 m (P=0.0125). For the intent-to-treat population, 6-minute walk distance improvements were observed at peak (26.0 m; P=0.0001) and trough (17.0 m; P=0.0025) plasma study drug concentrations. Other than an improvement in the combined 6-minute walk distance/Borg dyspnea score, there were no significant changes in secondary end points. Oral treprostinil therapy was generally well tolerated; the most common adverse events (intent-to-treat) were headache (69%), nausea (39%), diarrhea (37%), and pain in jaw (25%). CONCLUSIONS-: Oral treprostinil improves exercise capacity in PAH patients not receiving other treatment. Oral treprostinil could provide a convenient, first-line prostacyclin treatment option for PAH patients not requiring more intensive therapy. CLINICAL TRIAL REGISTRATION:-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00325403.

Original languageEnglish (US)
Pages (from-to)624-633
Number of pages10
JournalCirculation
Volume127
Issue number5
DOIs
StatePublished - Feb 5 2013

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Pulmonary Hypertension
Randomized Controlled Trials
Safety
Epoprostenol
Therapeutics
Dyspnea
Population
Placebos
treprostinil
Phosphodiesterase 5 Inhibitors
Random Allocation
Jaw
Nausea
Tablets
Headache
Diarrhea
Clinical Trials
Exercise
Pain

Keywords

  • Exercise test
  • prostacyclin analogue
  • pulmonary arterial hypertension
  • treprostinil

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Efficacy and safety of oral treprostinil monotherapy for the treatment of pulmonary arterial hypertension : A randomized, controlled trial. / Jing, Zhi Cheng; Parikh, Keyur; Pulido, Tomas; Jerjes-Sanchez, Carlos; White, R. James; Allen, Roblee P; Torbicki, Adam; Xu, Kai Feng; Yehle, David; Laliberte, Kevin; Arneson, Carl; Rubin, Lewis J.

In: Circulation, Vol. 127, No. 5, 05.02.2013, p. 624-633.

Research output: Contribution to journalArticle

Jing, ZC, Parikh, K, Pulido, T, Jerjes-Sanchez, C, White, RJ, Allen, RP, Torbicki, A, Xu, KF, Yehle, D, Laliberte, K, Arneson, C & Rubin, LJ 2013, 'Efficacy and safety of oral treprostinil monotherapy for the treatment of pulmonary arterial hypertension: A randomized, controlled trial', Circulation, vol. 127, no. 5, pp. 624-633. https://doi.org/10.1161/CIRCULATIONAHA.112.124388
Jing, Zhi Cheng ; Parikh, Keyur ; Pulido, Tomas ; Jerjes-Sanchez, Carlos ; White, R. James ; Allen, Roblee P ; Torbicki, Adam ; Xu, Kai Feng ; Yehle, David ; Laliberte, Kevin ; Arneson, Carl ; Rubin, Lewis J. / Efficacy and safety of oral treprostinil monotherapy for the treatment of pulmonary arterial hypertension : A randomized, controlled trial. In: Circulation. 2013 ; Vol. 127, No. 5. pp. 624-633.
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AU - Pulido, Tomas

AU - Jerjes-Sanchez, Carlos

AU - White, R. James

AU - Allen, Roblee P

AU - Torbicki, Adam

AU - Xu, Kai Feng

AU - Yehle, David

AU - Laliberte, Kevin

AU - Arneson, Carl

AU - Rubin, Lewis J.

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N2 - BACKGROUND-: Pulmonary arterial hypertension (PAH) is a progressive, fatal disease with no cure. Parenteral and inhaled prostacyclin analogue therapies are effective for the treatment of PAH, but complicated administration requirements can limit the use of these therapies in patients with less severe disease. This study was designed to evaluate the safety and efficacy of the oral prostacyclin analogue treprostinil diolamine as initial treatment for de novo PAH. METHODS AND RESULTS-: Three hundred forty-nine patients (intent-to-treat population) not receiving endothelin receptor antagonist or phosphodiesterase type-5 inhibitor background therapy were randomized (treprostinil, n=233; placebo, n=116). The primary analysis population (modified intent-to-treat) included 228 patients (treprostinil, n=151; placebo, n=77) with access to 0.25-mg treprostinil tablets at randomization. The primary end point was change from baseline in 6-minute walk distance at week 12. Secondary end points included Borg dyspnea index, clinical worsening, and symptoms of PAH. The week 12 treatment effect for 6-minute walk distance (modified intent-to-treat population) was 23.0 m (P=0.0125). For the intent-to-treat population, 6-minute walk distance improvements were observed at peak (26.0 m; P=0.0001) and trough (17.0 m; P=0.0025) plasma study drug concentrations. Other than an improvement in the combined 6-minute walk distance/Borg dyspnea score, there were no significant changes in secondary end points. Oral treprostinil therapy was generally well tolerated; the most common adverse events (intent-to-treat) were headache (69%), nausea (39%), diarrhea (37%), and pain in jaw (25%). CONCLUSIONS-: Oral treprostinil improves exercise capacity in PAH patients not receiving other treatment. Oral treprostinil could provide a convenient, first-line prostacyclin treatment option for PAH patients not requiring more intensive therapy. CLINICAL TRIAL REGISTRATION:-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00325403.

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