Letter to the Editor
Right Heart Catheterization Further Confirms Successful Transition from Parenteral Prostanoid to Oral Selexipag
El cateterismo cardíaco derecho confirma con éxito el cambio de prostanoides parenterales a selexipag vía oral
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Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "393" "paginaFinal" => "394" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Lázaro Salvador, Pilar Escribano Subías, Luis Rodriguez Padial" "autores" => array:3 [ 0 => array:4 [ "nombre" => "María" "apellidos" => "Lázaro Salvador" "email" => array:1 [ 0 => "maria.lasal@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Pilar" "apellidos" => "Escribano Subías" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Luis" "apellidos" => "Rodriguez Padial" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El cateterismo cardíaco derecho confirma con éxito el cambio de prostanoides parenterales a selexipag vía oral" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pulmonary arterial hypertension (PAH) is a progressive pulmonary vasculopathy with devastating prognosis. Only three therapeutic targets (endothelin, nitric oxide, and prostacyclin) are currently available to slow down the progression of the disease. Parenteral prostacyclin analogues are recommended in patients suffering from severe PAH with high-risk profile.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Treprostinil, a prostacyclin analogue, improves patients’ risk profile but frequently associates severe pain at infusion site. Oral selexipag is a novel orally available non-prostacyclin selective prostacyclin receptor (IP receptor) agonist,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> currently approved to treat intermediate risk PAH patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We recently reported the first successful switch from subcutaneous treprostinil to oral selexipag in a stable PAH patient reporting unbearable adverse events related to treprostinil subcutaneous administration.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Six months after treprostinil withdrawal, the patient non-invasive risk profile had slightly improved and her quality of life drastically increased. At that time invasive data were lacking. We relied on non-invasive prognostic markers (WHO FC, NTproBNP and 6MWD),<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> adding echocardiogram and cardiopulmonary exercise test parameters to increase accuracy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">There is still little experience with transition to oral selexipag from parenteral prostacyclin therapy,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> and further investigation is required to confirm safety and efficacy of this switch. Therefore, we communicate that one year has elapsed since our patient started transition to selexipag, and treprostinil was completely withdrawn more than 10 months ago. She maintains her previously achieved low risk profile,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and finally accepted to undergo right heart catheterization. Low risk profile achievement is now documented also invasively, and with longer follow up (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Taking into account that PAH is a progressive disease, the fact that the patient remains stable, in confirmed low risk profile, 10 months after withdrawal of parenteral prostanoids, highlights the safety of transition from parenteral prostanoids to oral selexipag in adequately selected patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">6MWD: 6<span class="elsevierStyleHsp" style=""></span>minutes walking distance; CPET: cardiopulmonary Exercise Test; VO<span class="elsevierStyleInf">2</span>: oxygen uptake; RA: right atrium; RAP: right atrial pressure; SvO<span class="elsevierStyleInf">2</span>: mixed venous oxygen saturation; CI: cardiac index.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Colors are: Red for high risk, Yellow for intermediate risk, Green for low risk. These are taking from risk evaluation table proposed in ESC/ERS Guidelines published in 2016, and used current in clinical daily practice.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "fx1.jpeg" "imagenAlto" => 1703 "imagenAncho" => 3000 "imagenTamanyo" => 698861 ] ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Risk profile assessment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Galie" 1 => "M. Humbert" 2 => "J.L. Vachiery" 3 => "S. Gibbs" 4 => "I. Lang" 5 => "A. Torbicki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "67" "paginaFinal" => "119" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Selexipag for the treatment of pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "GRIPHON study" "etal" => true "autores" => array:6 [ 0 => "Olivier Sitbon" 1 => "Richard Channick" 2 => "Kelly M. Chin" 3 => "Aline Frey" 4 => "Sean Gaine" 5 => "Nazzareno Galiè" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "373" "paginaInicial" => "2522" "paginaFinal" => "2533" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Living with severe pulmonary arterial hypertension without an infusion pump? Selexipag has a role to play" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Lázaro Salvador" 1 => "F. Akerström" 2 => "P. Escribano Subías" 3 => "A. Berenguel Senén" 4 => "V. Martinez Mateo" 5 => "L. Rodriguez Padial" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2018.03.010" "Revista" => array:2 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2018" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Boucly" 1 => "J. Weatherald" 2 => "L. Savale" 3 => "X. Jaïs" 4 => "V. Cottin" 5 => "G. Prevot" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.00889-2017" "Revista" => array:2 [ "tituloSerie" => "Eur Respir J" "fecha" => "2017" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transition from treprostinil to selexipag in patients with pulmonary arterial hypertension: case series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.M. Fanous" 1 => "M. Janmohamed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2146/ajhp170814" "Revista" => array:6 [ "tituloSerie" => "Am J Health Syst Pharm" "fecha" => "2018" "volumen" => "75" "paginaInicial" => "1877" "paginaFinal" => "1881" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30301721" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005500000007/v1_201907020949/S0300289619300389/v1_201907020949/en/main.assets" "Apartado" => array:4 [ "identificador" => "9222" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director / Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005500000007/v1_201907020949/S0300289619300389/v1_201907020949/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619300389?idApp=UINPBA00003Z" ]
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