Successful transition from Treprostinil to Selexipag in patient with severe pulmonary arterial hypertension

Background: In this report, we describe the first successful case of transition from subcutaneous administration of treprostinil to selexipag in a patient with severe pulmonary arterial hypertension (PAH), by evaluating hemodynamic changes and exercise tolerance. Case presentation: A 38-year-old female with idiopathic PAH (IPAH) had received initial triple combination therapy (macitentan PO, tadalafil PO, and treprostinil SC) and achieved excellent improvement in hemodynamics. Afterwards, due to the development of side effects from subcutaneous administration, we replaced treprostinil therapy with oral selexipag, resulting in stable hemodynamic parameters and exercise capacities. Conclusions: We report the first case of successful replacement of treprostinil (20.1 ng/kg/min) with selexipag (1600 mu g BID) as a component of triple combination therapy, which provides incentive to perform a larger, prospective exchange study.