Prostacyclin Drug Class

The role of endogenous prostacyclin in lung function

Naturally occurring prostacyclin plays a crucial role in physiological processes:

• Regulates blood vessel function, clotting, and inflammation¹
• Cumulatively helps to maintain tissue health throughout the body, including the lungs²
• Addresses the progressive vascular remodeling associated with PAH that leads to narrowed, thickened pulmonary blood vessels and, consequently, abnormal hemodynamics¹

Prostacyclin-class medications mimic naturally occurring prostacyclin

Prostacyclin-class therapies are distinctive in that they address the decrease in prostacyclin found in many patients with PAH. Not only do prostacyclin-class medications induce vasodilation; they also exhibit antithrombotic and antiproliferative properties. In addition, data show that prostacyclin-class medications may have anti-inflammatory effects.³

Prostacyclin-class therapy is an important consideration in all PAH therapy regimens

Treating patients with a combination therapy regimen that includes prostacyclin-class medication has shown improved outcomes and improvements in risk status vs monotherapy.⁵

Current PAH treatment guidelines recommend prostacyclin-class medications³:

• As initial therapy for patients at high risk
  • All patients starting PAH therapy should have follow-up within 3 months to reassess risk status
• As add-on therapy at first follow-up for patients not at low risk
  • Options for patients at intermediate low risk include oral and inhaled prostacyclins
  • Adding a parenteral prostacyclin is recommended for patients at intermediate high and high risk

Prostacyclin-class therapy administration options

Advances in prostacyclin development have led to more options for administration. With the variety of forms for prostacyclin administration, patients can titrate to a maintenance dose efficiently, safely, and effectively. The diverse administration choices also offer more opportunities to customize therapy according to a patient's disease status, needs, and lifestyle.

Prostacyclin-class therapies are available in oral and inhaled formulations, as well as through parenteral delivery.

Oral prostacyclins

Oral formulations are available in pill form, and in multiple dose strengths to make titration smoother.^19,20

Inhaled prostacyclins

Using inhaled formulations allows patients to deliver the prostacyclin medication directly to the small pulmonary vessels affected in PAH, facilitating fast titration.^21-23

Parenteral prostacyclins

(intravenous/subcutaneous)

Parenteral therapies provide continuous medication delivery to the patient through subcutaneous or intravenous routes via a pump, available in multiple options, including compact versions.^24,25

As therapy evolves, experience matters

Prostacyclins were the first class of therapy approved for PAH

Over the years, prostacyclin-class medications have been extensively researched, and current guidelines support their use throughout the management of PAH as part of a patient’s individualized treatment plan. Prostacyclin-class therapies have been studied in patients across functional classes (I-IV) as an important part of combination treatment regimens.^3,26,27

Prostacyclins continue to evolve today–updates in pump technology further refine parenteral treatment and enhance patient use.^17,25

Gaining experience with all forms of prostacyclin medications is important to understanding how the medications work and when they work best.

Why experience matters

HCPs with experience in patients with PAH accumulate vital knowledge and access to essential resources and tools necessary to provide comprehensive patient support.

• Patient circumstances and profile can, and often do, evolve. To navigate patient variables like lifestyle, risk status, and medication adherence, HCPs need to be adept in creating highly individualized treatment plans
• Continual monitoring every 3 to 6 months per current PAH treatment guidelines is critical, as patient needs change over time. HCPs must understand how to monitor, when it is time for a dose change, and how to help patients incorporate an additional therapy and lifestyle modifications³
• Prostacyclin therapy can be vital; determining where it fits into the treatment plan necessitates a thorough understanding of a patient's specific clinical profile, including functional class, comorbidities, and response to previous or current therapies. HCPs need experience to anticipate, recognize, and manage dose titration needs and potential dose responses and side effects