Intravenous prostacyclin-analogue therapy in pulmonary arterial hypertension - A review of the past, present and future

被引:10
作者
Stubbe, Beate [1 ]
Opitz, Christian F. [2 ,3 ]
Halank, Michael [4 ]
Habedank, Dirk [2 ,3 ]
Ewert, Ralf [1 ]
机构
[1] Univ Hosp Greifswald, Dept Internal Med B, Greifswald, Germany
[2] DRK Kliniken Berlin, Dept Cardiol, Berlin, Germany
[3] Charite Univ Med Berlin, Berlin, Germany
[4] Univ Klinikum Carl Gustav Carus, Bereich Pneumol, Med Klin 1, Dresden, Germany
关键词
Prostacyclin; Epoprostenol; Iloprost; Treprostinil; Pulmonary arterial hypertension; Implantable drug pump; BLOOD-STREAM INFECTIONS; SYSTEMIC-LUPUS-ERYTHEMATOSUS; LONG-TERM TREATMENT; INTERMITTENT ILOPROST INFUSION; EPOPROSTENOL PROSTACYCLIN; COMBINATION THERAPY; PORTOPULMONARY HYPERTENSION; TREPROSTINIL SODIUM; PROSTANOID THERAPY; IV TREPROSTINIL;
D O I
10.1016/j.rmed.2021.106336
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Therapy with intravenous prostacyclin analogues in patients with pulmonary arterial hypertension (PAH) has been established for decades and is an integral component of the current guidelines for the treatment of pulmonary hypertension. Initially, these drugs were infused by external pump systems via tunnelled right atrial catheters with the need for cooling and frequent exchange of drug reservoirs. Associated complications included, among others, catheter-related infections. More recently, fully implantable pump systems have been developed with drug reservoirs that are filled transcutaneously, allowing intervals between refills of several weeks. This technique results in a low rate of infections. Epoprostenol, iloprost and treprostinil have all been used intravenously in PAH, but titration, dosing and dose escalation in long-term therapy are not standardized. Intravenous prostacyclin analogues are still under-used, despite available data suggesting that early and broad application of these therapies as part of risk-oriented, guideline-directed combination therapy for patients with PAH may lead to a survival benefit. This review provides a detailed overview of the drugs, infusion systems and dosing strategies used for intravenous therapy in patients with PAH.
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页数:12
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