| ObjectiveTo observe and evaluate the efficacy and safety of treprostanil in patients with intermediate and high risk pulmonary hypertension.MethodsClinical data of 113 patients with pulmonary hypertension who received treprostinil treatment in the Guangzhou Medical University First Affiliated Hospital from January 1,2015 to December 31,2020 were retrospectively analyzed and followed up.Patients were divided into transplant group and non-transplant group according to whether patients received lung transplantation or combined heart and lung transplantation in subsequent treatment.Baseline data,clinical manifestations,laboratory test results and examination results of patients in the two groups were collected,respectively.The time from the first appearance of PH symptoms to the diagnosis of PH,medication method,initial and maintenance dose of troprostanil,side effects,duration of medication,time of drug withdrawal and reasons for drug withdrawal were recorded.Continuous follow-up was conducted during the follow-up treatment,and the survival of the enrolled patients as of December 31,2021 was recorded,and the effects of the above indicators on the survival prognosis of the patients were compared.Results1.Enrollment: A total of 113 intermediate and high risk patients with pulmonary hypertension treated with treprostinil were included in this study,including 97 patients in the non-transplant group and 16 patients in the transplant group.2.Clinical classification: Among the 97 patients in the non-transplantation group,45patients(46.39%)had pulmonary arterial hypertension,2 patients(2.3%)had pulmonary hypertension caused by left heart disease,26 patients(26.80%)had pulmonary hypertension caused by pulmonary disease and/or hypoxia,and 24 patients(24.74%)had chronic thromboembolic pulmonary hypertension.Among the 16 patients in the transplantation group,7(43.75%)had pulmonary arterial hypertension,1(6.25%)had pulmonary hypertension caused by left heart disease,and 8(50%)had pulmonary hypertension caused by pulmonary disease and/or hypoxia.3.Treatment: Among the 97 patients in the non-transplant group,subcutaneous pump(83.51%)was the main administration route of treprostinil therapy,with the majority starting dose of 1.25ng/kg/min(89.69%)and the maintenance dose of 10,10,15ng/kg/min(median,quantile).The median duration of treatment was 12.02 weeks(4.34 to17.36 weeks).In the transplantation group,16 patients received treprostinil via a subcutaneous pump with a starting dose of 1.25ng/kg/min,most patients received a maintenance dose of 15ng/kg/min,and most patients received treprostinil for 4-12 weeks(50%).The main side effects were local pain at the injection site(52.21%).In the transplantation group,7 patients received unilateral lung transplantation(43.75%),6patients received bilateral lung transplantation(37.50%),and 3 patients received combined heart and lung transplantation(18.75%).4.Treatment effect: The improvement rate of WHO function class in non-transplantation group was 41.24%,and the disease control rate was 86.60%.The improvement rate of lung transplantation group was 31.25%,and the disease control rate was 93.75%.Compared with patients receiving beraprost with similar baseline before transplantation,patients in the treprostinil group had shorter total hospital stay after transplantation(27.00 vs 34.29 days,P =0.039)and better survival(P =0.041).5.Survival prognosis: In the non-transplantation group,the 3-month cumulative survival rate was 94.38%,the 1-year cumulative survival rate was 83.05%,and the 3-year cumulative survival rate was 55.17%.In the transplantation group,the 3-month cumulative survival rate was 93.75%,the 1-year cumulative survival rate was 93.75%,and the 3-year cumulative survival rate was 75.00%.Multivariate Cox proportional risk model showed a1.935-fold increased risk of death in non-transplant patients who received tripropronil <12 weeks compared with those who received tripropronil > for 12 weeks [HR=2.935,95%CI(1.020=8.447),P =0.046].Lung transplant patients receiving beraprost had a1.449-fold increased risk of death compared with those receiving treprostinil [HR=2.449,95%CI(1.023-4.668),P =0.021].Conclusions1.This study preliminarily confirmed that treprostinil improved the survival rate of patients with PH,and WHO-FC remained stable or improved in patients.;2.According to the experience of our center,the stable dose of treprostinil for subcutaneous injection in most Chinese patients is about 10-15ng/kg/min,and the main adverse reactions are local pain at the injection site,which can be tolerated by most patients.;3.Early and long course(>12 weeks)use of treprostinil therapy benefited the survival rate in patients with PH;4.Compared with the application of beraprost,the application of treprostinil before transplantation in PH patients can shorten the length of hospital stay after transplantation and bring long-term survival benefits. |
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