Real-World Dosing and Persistence of Oral Treprostinil Initiation Strategies in Patients With Pulmonary Arterial Hypertension

In patients with pulmonary arterial hypertension (PAH), limited real-world data are available on persistence to oral treprostinil therapy, particularly while transitioning from parenteral prostacyclins. We compared persistence to oral treprostinil and total daily dose (TDD) achieved among patients with PAH initiating oral treprostinil de novo or while transitioning from parenteral prostacyclins using two real-world datasets: specialty pharmacy shipment records (Analysis 1) and ADAPT registry (Analysis 2). In Analysis 1, patients receiving oral treprostinil in 2017, 2020, and 2023 were included. In Analysis 2, de-identified data of patients enrolled in ADAPT from July 2017 to January 2022 were included. We conducted descriptive analyses and quantified persistence to oral treprostinil and TDD. In Analysis 1, the proportion of transition patients increased (24%–41%) from 2017 to 2023, whereas the proportion of de novo patients decreased (76%–59%). For the overall population, the mean initial oral treprostinil dose increased over the 3 years (6.0–8.9 mg TDD). The majority (61%) of patients transitioning to oral treprostinil were persistent with therapy at 12 months compared with de novo patients (47%). In Analysis 2, approximately 93% of transition patients and 77% of de novo patients were persistent on oral treprostinil therapy at 12 months. These analyses suggest that patients with PAH are increasingly being initiated on oral treprostinil while transitioning from parenteral prostacyclin rather than initiating de novo. Patients transitioning to oral treprostinil achieved and maintained higher TDD of oral treprostinil and persisted on oral treprostinil therapy longer than de novo patients.