A consensus document featuring 10 statements, the main focus of which was the use of parenteral prostanoids, was developed by eight experts in pulmonary arterial hypertension during in-person and web-based meetings. Forty-six Italian physicians were invited online to rate each statement, indicating their agreement, neutrality or disagreement. These consensus statements are intended to support physicians in starting parenteral prostanoids, minimizing delays that could negatively affect patient prognosis.
There was strong agreement among the physicians who took part in the rating that age and comorbidities deeply influence the choice of pulmonary arterial hypertension-targeted therapies. Agreement was also reached on the use of parenteral prostanoids in the following three clinical scenarios:
- treatment-naive patients at high risk;
- newly diagnosed patients classified as intermediate-risk, with severe right ventricular dysfunction assessed invasively
- prevalent high-risk patients, as defined by the 4-strata risk score.
The use of parenteral prostanoids in selected newly diagnosed intermediate-risk patients with severe right ventricular dysfunction assessed by imaging achieved a mild agreement. Three statements did not meet the predefined threshold for consensus.
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Citation
Manzi G, Badagliacca R, D’Alto M, Ghio S, Palazzini M, Romeo E, Scelsi L, Airò E, Argiento P, Baldi F, Bauleo C, Bonsante E, Carignola R, Carmina MG, Cannillo M, Casu G, Confalonieri M, Corda M, Correale M, D’Angelo L, De Michele L, Fortunato F, Galié N, Galgano G, Garascia A, Giuliani L, Marra WG, Madonna R, Mercurio V, Monti S, Mulé M, Paciocco G, Papa S, Pezzuto B, Prati D, Raineri C, Romaniello A, Renon F, Stolfo D, Vatrano M, Vitulo P, Manes A, Vizza CD. 2025 expert consensus on the use of parenteral prostanoids in incident and prevalent PAH patients: The Italian perspective. Vascul Pharmacol. 2026 Feb 27:107590. doi: 10.1016/j.vph.2026.107590. Epub ahead of print. PMID: 41765197.