Transitioning Between Treprostinil Formulations: Evidence and Strategies

Treprostinil is a prostacyclin analog available in four formulations: parenteral, oral, inhalation solution, and inhalation powder. All formulations of treprostinil are indicated for the treatment of pulmonary arterial hypertension; the inhaled formulations are also approved for pulmonary hypertension associated with interstitial lung disease. Transitions between formulations are frequent in clinical practice but lack standardized guidance. This review summarizes published evidence regarding safety, efficacy, and techniques of transitioning between treprostinil formulations. The evidence includes over 100 patients across various settings, with crossover transition strategies most frequently employed. Approximately 80% of cases reviewed were deemed successful; however, it should be noted there was no standardized definition for success across publications. Unsuccessful transitions were often linked to disease progression or intolerance to therapy. These findings underscore the importance of individualized transition strategies, informed by clinical status, patient preferences, and formulation-specific pharmacokinetics. By consolidating the current evidence, this review aims to support clinicians in optimizing transitions and maintaining continuity of treprostinil therapy.Graphical abstract available for this article.