Treprostinil (Remodulin) is an IV, SC, PO, and inhaled prostaglandin I2 analog used to treat pulmonary arterial hypertension (PAH) by causing vasodilation. Like other medications in this class, one must be wary about compounding systemic vasodilatory effects and platelet inhibition with other anti-hypertensives and anticoagulants, respectively. The subcutaneous administration of treprostinil via an infusion pump offers a nice alternative to intravenous administration which requires long term venous access (and associated infection/thrombus formation risks); however, infusion-site pain is a side effect experienced by many in addition to diarrhea, flushing, dizziness, and headaches.

As far as the evidence, SUBCUTANEOUS treprostinil therapy improved 6 minute walk test distances (6MWD) and hemodynamics versus placebo in a 12-week double-blinded RCT in 470 patients with PAH. In the TRIUMPH-1 trial, INHALED treprostinil improved 6MWD but not the time before signs of acute PAH worsening in patients who were already on other PAH therapies like sildenadil and bosentan. ORAL treprostinil has had evidence all over the map (FREEDOM-C, FREEDOM-M, FREEDOM-C2, FREEDOM-EV… you get the point) – some shows improvement in time before clinical worsening, other data shows no difference, and almost all of it is confounded by existing PAH therapies.

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