Transitioning between prostacyclin therapies
Two patients were prescribed triple combination therapy at baseline, including inhaled iloprost at doses of 5 μg six times a day. In both cases when selexipag was initiated at 200 μg twice daily, iloprost was simultaneously reduced to 5 μg four times a day by excluding the morning and the evening iloprost doses. Iloprost was then reduced to 5 μg twice daily in the second week, when selexipag was increased to 400 μg twice daily. This was well tolerated and inhaled iloprost was discontinued by week 3, with ongoing up titration of selexipag until individual maintenance doses were achieved. Final doses of 1200 μg twice daily and 1400 μg twice daily were achieved in these cases, which was significantly higher when compared to doses achieved by other patients in our centre. (p=0.037)