Evaluation of Inhaled Alprostadil in Hospitalized Adult Patients

Background: Intermittent inhaled alprostadil (iPGE(1)) may be a viable alternative to inhaled nitric oxide or epoprostenol for management of right ventricular failure, pulmonary hypertension (pHTN) or acute respiratory distress syndrome (ARDS). However, limited evidence exists regarding iPGE(1) use in adults, ideal dosing strategies, or optimal use cases. Objective To describe the clinical characteristics of patients receiving iPGE(1) and identify specific sub-populations warranting further research. Methods This was a single-center, retrospective, descriptive analysis of inpatients who received at least one dose of iPGE(1). The primary outcome was to describe patient characteristics and alprostadil dosing strategies. Secondary outcomes included changes in respiratory support requirements, hemodynamics, and inotropic/vasoactive use. Outcomes were stratified and compared based on primary therapeutic indication (cardiac or pulmonary). Results Fifty-four patients received iPGE(1) 40 (75%) for pulmonary (pHTN or ARDS) and 14 (25%) for cardiac indications. There was no difference between indications in the number of patients de-escalated from level of respiratory (53% vs 57%, P = 0.76), inotropic (70% vs 57%, P = 0.39), or vasopressor support (78% vs 57%, P = 0.17). Furthermore, there was no significant improvement in cardiopulmonary parameters at multiple time intervals after iPGE(1) initiation. Conclusion and Relevance This is the largest study to date on the use of intermittent iPGE(1) in adults. Alprostadil was safely utilized in novel populations; however, efficacy as evaluated by clinical or surrogate endpoints could not be demonstrated and further investigation is needed to determine its potential and optimal place in therapy.