In a study of 373 postmortem cases of adults (mean age, 39.6 years; 72.7% men) who had injected drugs, two-thirds had concomitant HCV, most were overweight or obese, and 3.8% had concomitant HIV.4

Nonsurgical Rescue in Patients With CTEPH

In patients who develop CTEPH, endarterectomy is usually the standard procedure for removing the emboli.5 However, up to 50% of patients cannot undergo the surgery due to persistent PH or PH after an endarterectomy.5

Roela Sadushi-Kolici, MD, from the Medical University of Vienna in Austria, and colleagues, sought to determine whether individuals who could not have endarterectomy could be treated with the prostacyclin analogue treprostinil.5 The 24-week study of 105 adults (mean age, 64 years; 47% women) randomly assigned 53 patients to high-dose treprostinil (30 ng/kg/min at week 12) and 52 patients to a lower dose (3 ng/kg/min at week 12).5 Although diarrhea, headache, and extremity pain were more common in the high-dose group, treprostinil demonstrated dose-dependent, long-term improvements in the 6-minute walk test, hemodynamics, World Health Organization functional class, and levels of N-terminal prohormone of brain natriuretic peptide.5

“While intravenous treatments are less desirable in CTEPH because intravenous lines are known causes of CTEPH, a subcutaneous approach for a parenteral treatment is the access of choice,” said coinvestigator and cardiology professor Irene M. Lang, MD, also from the Medical University of Vienna. “Since [our study] has been published, patients with severe disease have been successfully bridged to surgical pulmonary endarterectomy, and, most recently and more often, to balloon pulmonary angioplasty.”

Summary & Clinical Applicability

While pulmonologists may be aware of certain drugs that are implicated in PAH, they should also suspect injected drugs, particularly methamphetamines; this has caused an increase in the number of PAH cases, which had previously been classified as idiopathic.

Limitations & Disclosures

None.

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References

  1. DeJesus Perez VA. Drug-induced pulmonary hypertension: the first 50 years. Adv Pulmon Hypertens. 2017;15(3):133-137.
  2. McGee M, Whitehead N, Twaddell S, Collins N. Pulmonary hypertension in patients with a history of intravenous drug use [published online December 14, 2018]. Curr Med Res Opin. doi:10.1080/03007995.2018.1558863
  3. Chin KM, Channick RN, Rubin LJ. Is methamphetamine use associated with idiopathic pulmonary arterial hypertension? CHEST. 2006;130(6):1657-1663.
  4. Darke S, Duflou J, Torok M. The health consequences of injecting tablet preparations: foreign body pulmonary embolization and pulmonary hypertension among deceased injecting drug users. Addiction. 2015;110(7):1144-1151.
  5. Sadushi-Kolici R, Jansa P, Kopec G, et al. Subcutaneous treprostinil for the treatment of severe non-operable chronic thromboembolic pulmonary hypertension (CTREPH): a double-blind, phase 3, randomised controlled trial. Lancet Respir Med. 2019;7(3):239-248.

This article originally appeared on Pulmonology Advisor