Effect of aerosolized recombinant human dnase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis

Background: Respiratory disease in patients with cystic fibrosis is characterized by airway obstruction caused by the accumulation of thick, purulent secretions, which results in recurrent, symptomatic exacerbations. The viscoelasticity of the secretions can be reduced in vitro by recombinant human deoxyribonuclease I (rhDNase), a bioengineered copy of the human enzyme. Methods: We performed a randomized, double-blind, placebo-controlled study to determine the effects of once-daily and twice-daily administration of rhDNase on exacerbations of respiratory symptoms requiring parenteral antibiotics and on pulmonary function. A total of 968 adults and children with cystic fibrosis were treated for 24 weeks as outpatients. Results: One or more exacerbations occurred in 27 percent of the patients given placebo, 22 percent of those treated with rhDNase once daily, and 19 percent of those treated with rhDNase twice daily. As compared with placebo, the administration of rhDNase once daily and twice daily reduced the age-adjusted risk of respiratory exacerbations by 28 percent (P = 0.04) and 37 percent (P<0.01), respectively. The administration of rhDNase once daily and twice daily improved forced expiratory volume in one second during the study by a mean (±SD) of 5.8 ±0.7 and 5.6 ±0.7 percent, respectively. None of the patients had anaphylaxis. Voice alteration and laryngitis were more frequent in the rhDNase-treated patients than in those receiving placebo but were rarely severe and resolved within 21 days of onset. Conclusions: In patients with cystic fibrosis, the administration of rhDNase reduced but did not eliminate exacerbations of respiratory symptoms, resulted in slight improvement in pulmonary function, and was well tolerated., Respiratory disease in patients with cystic fibrosis is characterized by airway obstruction caused by the accumulation of thick, purulent secretions, recurrent exacerbations of respiratory symptoms, and progressive deterioration of lung function¹. In such patients chronic bacterial colonization of the airways develops, usually with Staphylococcus aureus or Pseudomonas aeruginosa, and often before the age of three years². Despite the use of potent antibiotics, often administered parenterally, airway infection persists. The average survival of patients with cystic fibrosis is approximately 29 years; more than 90 percent die of lung disease³. Two macromolecules that contribute to the physical properties of…