Targeting of dornase alpha therapy in adult XXXX .

@entity1 @entity1577
Although dornase alpha (recombinant @entity1 DNase) can thin the viscid pulmonary secretions of @entity1577 ( @entity1577 ), clinical trials in groups of unselected @entity1 have shown only modest average improvements in pulmonary function. The product is very expensive, so in conjunction with purchasers we designed selection criteria and a protocol for a 2-week trial to target @entity1577 individuals who might gain most benefit. Treatment was to be continued in those showing > or = 10% improvement in pulmonary function. Those who had a trial of dornase alpha were followed up for 2 years. Of 25 @entity1 who had a 2-week trial of dornase alpha, 17 met the criteria for continuation (average gain in forced expiratory volume 37%). The 11 of these who were still alive at 2 years had a greater initial average FEV1 improvement than those who had died (45% versus 22%), and still had an average improvement of 31% at 2 years. The 8 @entity1 who did not meet the criteria for continuation were older and had required fewer intravenous antibiotic courses. All these were alive at 2 years with unchanged clinical indices. This method of selection for dornase alpha treatment allows targeting to those who gain most benefit without disadvantaging the remaining @entity1 . Furthermore, production of such guidelines in conjunction with purchasers obviates funding difficulties and allows rational prescribing.
