Prostacyclin-Class Therapy

Prostacyclin-class therapies have unique characteristics

Prostacyclins were the first class of therapy approved for PAH, and their use in managing PAH has evolved substantially over time. Historically, prostacyclin-class therapies have been used primarily in patients with more severe disease or as a rescue-type therapy.¹ However, current evidence supports the use of prostacyclin-class therapies throughout PAH management in appropriate patients, and prostacyclin-class therapies can be combined with other classes of PAH medications as part of an individualized management plan. The availability of expanded treatment delivery options has also enabled prostacyclin-class therapies to be more conveniently integrated into patients’ daily lives.²

Prostacyclin-class medications are available in 3 different forms

Prostacyclin-class therapies are available in oral and inhaled formulations, as well as through parenteral delivery.² These varying routes of administration provide the flexibility to match your patient’s disease status and lifestyle.

Prostacyclin-class medications mimic the diverse functions of naturally occurring PCY

PAH is associated with progressive vascular remodeling resulting in narrowed, thickened pulmonary blood vessels.⁶ Although the exact mechanisms of PAH are unknown, most PAH medications induce vasodilation to counteract the narrowed blood vessels, each via a different pathway. Prostacyclin-class medications differ in that they not only induce vasodilation but also have significant antithrombotic and antiproliferative properties.⁷ In addition, some data suggest prostacyclin-class medications may contribute to anti-inflammatory effects.⁸

AEs associated with prostacyclin-class therapies include headache, diarrhea, flu-like symptoms, jaw pain, nausea, muscle pain, and flushing.⁹ Additional AEs may be specific to the drug and route of administration.^3-5

Prostacyclins can improve prognostic measures of risk

• Improved PAH symptoms^10,11
• Improved prognostic measures of risk
  • Functional Class^10,12
  • 6MWD^10,12
  • BNP/NT-proBNP^12,13
  • Hemodynamics^10,11
• Delayed disease progression^3,14

Prostacyclin-class therapies may be considered as part of a combination therapy approach in PAH

More pathways may mean better results

Combination therapy regimens—including those that contain a prostacyclin-class medication—are a mainstay of PAH management, as patients on combination therapy have shown improved outcomes vs patients on monotherapy.^2,12,15,16

The AMBITION study was pivotal in establishing the benefits of early combination therapy in patients with PAH. Nonetheless, despite being on dual oral therapy under optimal conditions, only 39% of patients achieved a satisfactory clinical response.¹⁶ In another study of patients initiated on dual combination therapy, most patients did not achieve low-risk status within 6 months.¹⁷

Another approach is to consider a combination regimen that includes a prostacyclin-class therapy. In combination studies with a prostacyclin-class therapy, improvements were seen in common PAH endpoints such as 6MWD, NT-proBNP, and delay in disease progression.^10-14