CORRESPONDENCE: LETTER TO THE EDITOR
Pulmonary Artery Hypertension: The Link Between Prostanoids and Bloodstream Infections
John R. Kapoor, MD, PhD*
* Division of Cardiology, Stanford University, 300 Pasteur Drive, Stanford, California 94305 (Email: jkapoor{at}stanford.edu).
Because of their vasodilatory and antiproliferative effects, the administration of prostanoids has become an important part of treatment for patients with pulmonary arterial hypertension (PAH). The intravenous infusion of the 2 prostanoids, epoprostenol (epoprostenol sodium [brand name Flolan, Glaxo SmithKline, Research Triangle Park, North Carolina]) and treprostinil (treprostinil sodium [brand name Remodulin, United Therapeutics, Silver Spring, Maryland]) are approved by the U.S. Food and Drug Administration for use in patients with PAH and are commonly used in many centers today. These drugs are discussed by Chin and Rubin (1) in their review on the topic in a recent issue of the Journal. However, there is no mention of the caution raised by a study performed at 7 PAH centers during 2003 to 2006 by the Centers for Disease Control and Prevention (CDC) on the possible link between treprostinil and greater rates of bloodstream infections (BSIs); (primarily gram-negative infections) when compared with the use of intravenous epoprostenol (2). The overall BSI pooled mean rate (per 1,000 medicine days) was 1.11 for patients receiving treprostinil compared with 0.43 in those receiving epoprostenol (pooled incidence rate ratio: 2.57; 95% confidence interval: 1.81 to 3.64). The pooled mean rate for gram-negative BSIs was 0.76 among patients on treprostinil compared with 0.06 in patients on epoprostenol (pooled incidence rate ratio: 12.77; 95% confidence interval: 6.55 to 26.80) (2). The CDC noted that "health-care providers who care for PAH patients should be aware of these findings." The reasons for these observed differences are unknown and may in part be related to the drug's differing anti-inflammatory effects. Therefore, further studies are needed to determine the reason for the observed increased BSI rate with treprostinil when compared with epoprostenol.
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1. Chin KM, Rubin LJ. Pulmonary arterial hypertension J Am Coll Cardiol 2008;51:1527-1538.[Abstract/Free Full Text]2. Centers for Disease Control and Prevention (CDC) Bloodstream infections among patients treated with intravenous epoprostenol or intravenous treprostinil for pulmonary arterial hypertension-seven sites, United States, 2003–2006 MMWR Morb Mortal Wkly Rep 2007;56:170-172.[Medline]
Related Article
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Reply
- Kelly M. Chin and Lewis J. Rubin
J. Am. Coll. Cardiol. 2008 52: 792.
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