Add-On Therapy with Subcutaneous Treprostinil for Refractory Pediatric Pulmonary Hypertension

Objective To evaluate the efficacy and tolerability of subcutaneous (SC) treprostinil, a prostacyclin analogue, in young children with refractory pulmonary arterial hypertension. Study design Eight children (median age, 4 years) received SC treprostinil therapy after failure of combined oral treatment (n = 7) or because of severe complications with intravenous epoprostenol (n = 1). Treprostinil was delivered through an SC catheter at gradually increasing doses to an average of 40 ng/kg/min, depending on the presence of adverse effects. Results Seven patients demonstrated early significant improvement (in functional class, hemodynamics, and/or 6-minute walk distance; P < . 05), and 6 had a sustained good response. Site pain could be effectively managed in all but one child. Conclusions Treprostinil may be a potentially valuable rescue therapy in children with refractory pulmonary arterial hypertension, but further study in a larger number of patients is needed. (J Pediatr 2011; 158:584-8).