Subcutaneous Treprostinil in PH Associated With Left Heart Disease or Chronic Lung Disease

Pulmonary hypertension (PH) associated with left heart disease (LHD-PH) and pulmonary hypertension associated with chronic lung disease (CLD-PH) are the most common PH subtypes but lack effective treatments. In a prospective cohort study, 90 patients (39 LHD-PH, 51 CLD-PH) with severe disease [pulmonary vascular resistance (PVR) > 5 Wood units and recent right heart failure (RHF)] were treated with subcutaneous Treprostinil (scTRE). Clinical, echocardiographic, and hemodynamic parameters were assessed at baseline and at 12 months; survival was tracked for 5 years. In LHD-PH and CLD-PH patients at 12 months, 6-min walking distance (6MWD) improved by 88 m [64;112] and 52 m [22;89], respectively, World Health Organisation functional class (WHO FC) improved in 77% and 78% of patients and mean pulmonary artery pressure (mPAP) decreased by 5.78 mmHg and 9.05 mmHg, respectively. Tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio improved in patients with CLD-PH. Median scTRE dose at 12 months was 30 ng/kg/min. Overall survival at 5 years was 38.6% in LHD-PH group and 49.7% in CLD-PH group. Patients with baseline pulmonary arterial wedge pressure (PAWP) < 12 mmHg had better outcomes. Open-label scTRE was associated with a spectrum of clinically relevant benefits in a select group of LHD-PH and CLD-PH patients recently hospitalized for RV failure and was well tolerated.