TRANSITIONING FROM INHALED ILOPROST TO ORAL SELEXIPAG: A CASE REPORT

Abstract

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: The TRANSIT-1 study looked into transition from inhaled Treprostinil to oral Selexipag (SXP) over the course of 16 weeks[1]. To our knowledge, similar published studies or case series regarding transition from inhaled Iloprost (ILO) to SXP are not yet available. We report the safe transition of a patient with connective tissue disease associated pulmonary arterial hypertension (CTD-PAH) from ILO over to SXP. CASE PRESENTATION: 52 y/o woman with SLE-SSc overlap, Raynauds syndrome, CTD-PAH, & resolved past APLA-related PEs on indefinite warfarin, had been on Bosentan 125mg BID & ILO 5mcg 6 inhalations a day for many years. Patient’s CTD-PAH had been stable at WHO FC 2. She had minimal adverse effects from her current medication regimen. Recently, patient expressed a preference for SXP over ILO. Transition was planned based on GRIPHON study[2] . Parallel up-titration of SXP with down-titration of ILO was performed, while patient continued to take Bosentan. For the 1st week, SXP was started at 200mcg BID in addition to usual 6 inhalations daily ILO. SXP was increased by 200mcg BID per week, while ILO was decreased by 3 inhalations per week. By 3rd week, patient took 600 mcg BID of SXP only, her highest tolerable dose. Throughout the transition, patient was in regular communication with the provider & a visiting specialty pharmacy nurse. Adverse reactions reported were nausea and episodic vomiting, which resolved with time & supportive care. Patient maintained her WHO FC & oxygenation, & had no clinical signs of right heart failure. DISCUSSION: The efficacy adverse profile for SXP against placebo is similar to ILO[2-4]. No head to head comparison is available for both drugs. TRANSIT-1 reported side-effect of muscle bleeding for a patient on warfarin. Our patient didn’t report any such event. TRANSIT-1 study continued their parallel titration for 8 weeks, followed by close monitoring for 4 weeks. In contrast, our patient safely stopped her ILO by the 2nd week, while continued the up-titration of SXP to tolerance. CONCLUSIONS: Our case report suggests that a relatively rapid & safe transition from ILO over to SXP is possible in clinically stable patients with CTD-PAH & relatively better preserved functional status. Reference #1: Frost, A., et al., Safety and tolerability of transition from inhaled treprostinil to oral selexipag in pulmonary arterial hypertension: Results from the TRANSIT-1 study. J Heart Lung Transplant, 2019. 38(1): p. 43-50. Reference #2: Sitbon, O., et al., Selexipag for the Treatment of Pulmonary Arterial Hypertension. N Engl J Med, 2015. 373(26): p. 2522-33. Reference #3: Olschewski, H., et al., Inhaled Iloprost for Severe Pulmonary Hypertension. New Engl J Med, 2002. 347(5): p. 322-329. DISCLOSURES: No relevant relationships by Sajeer Bhura, source=Web Response No relevant relationships by William Gibbons, source=Web Response