LAUSR

Prostacyclin analogues targeting the prostacyclin pathway are used to treat patients with pulmonary arterial hypertension (PAH), and are given either by an intravenous, subcutaneous or inhaled route [1]. Continuous i.v. infusion of epoprostenol has received the strongest recommendation for treatment of the most severe forms of PAH [2], mainly because it is the only PAH-specific drug that was demonstrated to give an improvement in survival in a randomised controlled study [3]. Due to drawbacks associated with its i.v. administration, epoprostenol is preferentially offered to young, high-risk patients [2]. For PAH patients in New York Heart Association (NYHA) functional class (FC) III/IV with severe haemodynamic impairment, epoprostenol can be combined with an endothelin receptor antagonist (ERA) and a phosphodiesterase type-5 (PDE-5) inhibitor to achieve sustained clinical and haemodynamic efficacy [4, 5]. Even for patients who are very stable while receiving i.v. epoprostenol over a long period of time, any transition to selexipag warrants careful long-term clinical and haemodynamic follow-up because worsening is likely to occur http://bit.ly/32wR9eX