Treprostinil 25mg/10ml solution for infusion vials

BackgroundPaediatric pulmonary arterial hypertension (PAH) shares commonalities with adult disease but is essentially different regarding complexity and is usually more challenging to treat. Current treatment recommendations are based on expert opinion, small-scale paediatric studies and knowledge and consolidated guidelines for adults. Parenteral prostacyclins are recommended for high-risk patients but evidence is limited to cohort studies and retrospective data evaluations. The aim of this article was to summarise the available evidence on the efficacy and safety of parenteral treprostinil for paediatric PAH through a systematic review and to evaluate selected efficacy end-points through meta-analysis.MethodA systematic literature search (January 2000-April 2024) was conducted in PubMed, Google Scholar and clinical trial registries. Eligible studies included those reporting long-term outcomes of parenteral treprostinil in children with PAH. Moreover, a meta-analysis of selected efficacy end-points was performed based on published results from studies meeting predefined criteria.Results32 studies encompassing 766 paediatric PAH patients treated with parenteral prostacyclins were identified; 649 patients received treprostinil. The meta-analysis was based on five publications including a total of 143 treprostinil-naïve patients. Despite the lack of randomised controlled trials, available data clearly indicate a treatment benefit of parenteral treprostinil in paediatric PAH. Literature data are supported by statistically significant results in the meta-analysis for PAH-relevant efficacy end-points.ConclusionBased on currently available published data, parenteral treprostinil is effective and safe in the treatment of paediatric PAH.

Abstract licence: CC BY

Autoimmune connective tissue disease associated with interstitial lung disease (CTD-ILD) includes rheumatoid arthritis-associated ILD, systemic sclerosis-associated-ILD, and several other ILDs. Many patients with CTD-ILD-as well as individuals with other ILDs-develop a progressive pulmonary fibrosis (PPF) similar to idiopathic pulmonary fibrosis (IPF). PPF is characterized by worsening respiratory symptoms, declining lung function despite current pharmacotherapies, and ultimately early death. Current pharmacotherapies for CTD-ILD and PPF include glucocorticoids, immunosuppressants, and anti-fibrotic agents. Due to the scarcity of randomized clinical trials for CTD-ILD, many pharmacotherapies are generally administered off-label (although several are approved in Japan), with notable exceptions including nintedanib, an anti-fibrotic agent approved for SSc-ILD and chronic progressive fibrosing ILD in several countries. As the available agents only slow the decline of pulmonary function and are associated with treatment-limiting side effects, there is a need for more efficacious and tolerable pharmacotherapies for CTD-ILD and PPF. Promising compounds in clinical trials include nerandomilast (a preferential phosphodiesterase 4B inhibitor), admilparant (a lysophosphatidic acid receptor 1 antagonist), and inhaled treprostinil (a prostacyclin analogue). Nerandomilast may have both anti-fibrotic and immunomodulatory properties; in preclinical models of PPF, it reduced neutrophils and macrophages and down-regulated pro-fibrotic signaling pathways. Hopefully, therefore, this pipeline will produce new medications to ease the collectively large burden of CTD-ILD and PPF.

Abstract licence: CC BY