Introduction: Parenteral
treprostinil for patients with
pulmonary arterial hypertension has resulted in improvement of exercise capacity, functional class, hemodynamics, and survival. Recently, a first randomized trial performed in patients with chronic thromboembolic
pulmonary hypertension confirmed the efficacy of subcutaneous
treprostinil in this subset of
pulmonary hypertension. Areas covered:
Treprostinil sodium is a
prostacyclin analog produced synthetically.
Drug characteristics include potent systemic and pulmonary vasodilatory effects. Local side-effects of subcutaneous
treprostinil have been an obstacle for its use. However, in contrast to other
prostacyclins,
treprostinil has favorable features. We performed a literature survey by searching PubMed for clinical trials published in any language, investigating medicinal treatments for CTEPH. We used the search terms 'inoperable', and 'chronic thromboembolic
pulmonary hypertension' with 'randomized clinical trial', and have put
treprostinil for CTEPH in the contest of published literature. Expert opinion: Drugs approved for PAH have recently shown excellent efficacy in patients with non-operable CTEPH. Rather than head-to-head comparisons of drugs, combination treatments are to be expected in the near future. Furthermore, drugs will have to be tested alongside with pulmonary
endarterectomy (PEA), and alongside balloon pulmonary angioplasty, a promising percutaneous mechanical treatment for CTEPH that is not suited for PEA.