Inhaled treprostinil improves persistence, lowers risk for PAH hospitalization vs. iloprost
Click Here to Manage Email Alerts
SAN FRANCISCO — Inhaled treprostinil significantly improved persistence, adherence and lowered risk for hospitalization compared with iloprost in patients with pulmonary arterial hypertension, researchers reported.
“For approved inhaled therapies, we have really two. Inhaled treprostinil is administered four times a day and iloprost must be administered six to nine times. The worry is that the more frequently you have to take a medication, the more difficult it is, particularly if you are having side effects such as cough or throat irritation at the time that it’s administered,” Charles D. Burger, MD, FCCP, pulmonologist in the department of medicine at Mayo Clinic in Jacksonville, Florida, told Healio during the American Thoracic Society International Conference.
Burger and colleagues conducted a retrospective, longitudinal cohort study analyzing administrative claims data from 467 adults with PAH (mean age, 64.2 years; 67.5% women) in the Optum de-identified Clinformatics Data Mart from January 2010 to September 2020. All patients were new initiators of inhaled treprostinil (United Therapeutics; n = 405) or iloprost (Bayer; n = 62) and had one or more inpatient or two or more outpatient medical claims with a pulmonary hypertension diagosnis separated by 30 days or longer.
The primary outcomes were persistence and adherence to patients’ medications, hospitalization and ED visits, and health care costs.
Sixty-six percent of patients who initiated inhaled treprostinil and 69.4% of patients who initiated iloprost had Medicare insurance.
At 6 months, medication persistence was higher among those in the inhaled treprostinil group compared with the iloprost group (65% vs. 35%; P < .0001). By 12 months, persistence remained higher for inhaled treprostinil (47% vs. 16%: P < .0001).
During the 12-month period, patients who initiated inhaled treprostinil had a 58% reduced risk for medication discontinuation compared with those who initiated iloprost (HR = 0.42; 95% CI, 0.3-0.58; P < .0001) in a multivariate analysis.
The inhaled treprostinil group also achieved a higher proportion of days covered 0.6 or more to index therapy compared with the iloprost group (50.9% vs. 22.6%).
During the 12-month period, hospitalization (54.8% vs. 39.3%; P = .0203) and ED visits (50% vs. 36.3%; P = .0385) were highest among patients who initiated iloprost compared with inhaled treprostinil. Researchers observed a 29% reduced risk for any hospitalization during the 12 months among those in the inhaled treprostinil group compared with those in the iloprost group (RR = 0.71; 95% CI, 0.54-0.92; P = .0103).
For health care costs, there were no differences in all-cause costs between the inhaled treprostinil group and the iloprost group in the patients that remained on therapy at 12 months.
“If you can give a medication less frequently, with fewer side effects, patients are more likely to stay on. We need to simplify the way that the therapies are inhaled and maybe give them less frequently. Hopefully, ways of preparing the medication will allow giving higher doses with less side effects. Those are three areas of focus looking ahead,” Burger told Healio.