Transition from treprostinil to selexipag in patients with pulmonary arterial hypertension: Case series

Purpose. Safe transition of patients with pulmonary arterial hypertension (PAH) from parenteral treprostinil to oral selexipag therapy in both inpatient and outpatient settings is described. Summary. There is a paucity of published data on how to safely transition patients to oral therapy in the event of complications and problems during parenteral administration of prostacyclins, which can include bloodstream infections, injection-site pain (with use of subcutaneous treprostinil), infusion pump malfunction, and dosing errors due to incorrect dose preparation. This case series describes the transition of 4 patients with World Health Organization (WHO) group I PAH (WHO functional classes II-IV) from i.v. (n = 3) and subcutaneous (n = 1) treprostinil infusion therapy to oral selexipag use. The transition process was completed through the use of 2 cross-titration methods (rapid and slow). A rapid approach was used in 2 cases involving inpatients, with parenteral-to-oral transition completed over 8-13 days; a slow transition method was used in 2 cases, in which outpatients completed the transition over 19-25 weeks. Adverse events during the transitions were headache, nausea, vomiting, diarrhea, and jaw pain. Conclusion. Four patients with WHO group I PAH who were not candidates for continued parenteral treprostinil therapy were safely transitioned to oral selexipag in both inpatient and outpatient settings.