Clinical use of dornase alfa is associated with a slower rate of FEV 1 decline in cystic fibrosis

Michael W. Konstan, Jeffrey S. Wagener, David J. Pasta, Stefanie J. Millar, Joan R. Jacobs, Ashley Yegin, Wayne J Morgan

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Abstract

Objectives Randomized controlled trials of dornase alfa have shown forced expiratory volume in 1 sec (FEV1) to improve in patients with cystic fibrosis (CF) but have not assessed change in the rate of lung function decline. We assessed the relationship of dornase alfa use and FEV1 decline using the Epidemiologic Study of Cystic Fibrosis (ESCF). Methodology Patients aged 8-38 years who had been enrolled in ESCF for 2 years when initially treated with dornase alfa were selected if they remained on treatment during the following 2 years. A comparator group included patients aged 8-38 who were not yet reported to have received dornase alfa. For each patient we estimated the annual rate of decline in FEV1% predicted before and after the index using a mixed-effects model adjusted for age, gender, pulmonary exacerbations, respiratory therapies, and nutritional supplements. Results The dornase alfa group (n = 2,230) had a lower FEV1% predicted at index and a more rapid decline during the pre-index period. The mean rate of FEV1 decline improved for the dornase alfa group; the improvement was similar in adults and children 8-17 years old but was not statistically significant in adults. The comparator group (n = 5,970) showed no change among adults and an increased rate of decline among children 8-17 years old. Conclusions The use of dornase alfa for a 2-year period is associated with a reduction in the rate of FEV1 decline. These results also demonstrate the value of using an observational study to assess the association of instituting new therapies in the clinical setting with changes in the rate of FEV1 decline in patients with CF.

Original languageEnglish (US)
Pages (from-to)545-553
Number of pages9
JournalPediatric Pulmonology
Volume46
Issue number6
DOIs
StatePublished - Jun 2011

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Forced Expiratory Volume
Cystic Fibrosis
Epidemiologic Studies
Respiratory Therapy
Lung
dornase alfa
Observational Studies
Randomized Controlled Trials
Therapeutics

Keywords

  • cystic fibrosis
  • dornase alfa
  • epidemiology
  • pulmonary function

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

Konstan, M. W., Wagener, J. S., Pasta, D. J., Millar, S. J., Jacobs, J. R., Yegin, A., & Morgan, W. J. (2011). Clinical use of dornase alfa is associated with a slower rate of FEV 1 decline in cystic fibrosis. Pediatric Pulmonology, 46(6), 545-553. https://doi.org/10.1002/ppul.21388

Clinical use of dornase alfa is associated with a slower rate of FEV 1 decline in cystic fibrosis. / Konstan, Michael W.; Wagener, Jeffrey S.; Pasta, David J.; Millar, Stefanie J.; Jacobs, Joan R.; Yegin, Ashley; Morgan, Wayne J.

In: Pediatric Pulmonology, Vol. 46, No. 6, 06.2011, p. 545-553.

Research output: Contribution to journalArticle

Konstan, MW, Wagener, JS, Pasta, DJ, Millar, SJ, Jacobs, JR, Yegin, A & Morgan, WJ 2011, 'Clinical use of dornase alfa is associated with a slower rate of FEV 1 decline in cystic fibrosis', Pediatric Pulmonology, vol. 46, no. 6, pp. 545-553. https://doi.org/10.1002/ppul.21388
Konstan, Michael W. ; Wagener, Jeffrey S. ; Pasta, David J. ; Millar, Stefanie J. ; Jacobs, Joan R. ; Yegin, Ashley ; Morgan, Wayne J. / Clinical use of dornase alfa is associated with a slower rate of FEV 1 decline in cystic fibrosis. In: Pediatric Pulmonology. 2011 ; Vol. 46, No. 6. pp. 545-553.
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abstract = "Objectives Randomized controlled trials of dornase alfa have shown forced expiratory volume in 1 sec (FEV1) to improve in patients with cystic fibrosis (CF) but have not assessed change in the rate of lung function decline. We assessed the relationship of dornase alfa use and FEV1 decline using the Epidemiologic Study of Cystic Fibrosis (ESCF). Methodology Patients aged 8-38 years who had been enrolled in ESCF for 2 years when initially treated with dornase alfa were selected if they remained on treatment during the following 2 years. A comparator group included patients aged 8-38 who were not yet reported to have received dornase alfa. For each patient we estimated the annual rate of decline in FEV1{\%} predicted before and after the index using a mixed-effects model adjusted for age, gender, pulmonary exacerbations, respiratory therapies, and nutritional supplements. Results The dornase alfa group (n = 2,230) had a lower FEV1{\%} predicted at index and a more rapid decline during the pre-index period. The mean rate of FEV1 decline improved for the dornase alfa group; the improvement was similar in adults and children 8-17 years old but was not statistically significant in adults. The comparator group (n = 5,970) showed no change among adults and an increased rate of decline among children 8-17 years old. Conclusions The use of dornase alfa for a 2-year period is associated with a reduction in the rate of FEV1 decline. These results also demonstrate the value of using an observational study to assess the association of instituting new therapies in the clinical setting with changes in the rate of FEV1 decline in patients with CF.",
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AU - Morgan, Wayne J

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N2 - Objectives Randomized controlled trials of dornase alfa have shown forced expiratory volume in 1 sec (FEV1) to improve in patients with cystic fibrosis (CF) but have not assessed change in the rate of lung function decline. We assessed the relationship of dornase alfa use and FEV1 decline using the Epidemiologic Study of Cystic Fibrosis (ESCF). Methodology Patients aged 8-38 years who had been enrolled in ESCF for 2 years when initially treated with dornase alfa were selected if they remained on treatment during the following 2 years. A comparator group included patients aged 8-38 who were not yet reported to have received dornase alfa. For each patient we estimated the annual rate of decline in FEV1% predicted before and after the index using a mixed-effects model adjusted for age, gender, pulmonary exacerbations, respiratory therapies, and nutritional supplements. Results The dornase alfa group (n = 2,230) had a lower FEV1% predicted at index and a more rapid decline during the pre-index period. The mean rate of FEV1 decline improved for the dornase alfa group; the improvement was similar in adults and children 8-17 years old but was not statistically significant in adults. The comparator group (n = 5,970) showed no change among adults and an increased rate of decline among children 8-17 years old. Conclusions The use of dornase alfa for a 2-year period is associated with a reduction in the rate of FEV1 decline. These results also demonstrate the value of using an observational study to assess the association of instituting new therapies in the clinical setting with changes in the rate of FEV1 decline in patients with CF.

AB - Objectives Randomized controlled trials of dornase alfa have shown forced expiratory volume in 1 sec (FEV1) to improve in patients with cystic fibrosis (CF) but have not assessed change in the rate of lung function decline. We assessed the relationship of dornase alfa use and FEV1 decline using the Epidemiologic Study of Cystic Fibrosis (ESCF). Methodology Patients aged 8-38 years who had been enrolled in ESCF for 2 years when initially treated with dornase alfa were selected if they remained on treatment during the following 2 years. A comparator group included patients aged 8-38 who were not yet reported to have received dornase alfa. For each patient we estimated the annual rate of decline in FEV1% predicted before and after the index using a mixed-effects model adjusted for age, gender, pulmonary exacerbations, respiratory therapies, and nutritional supplements. Results The dornase alfa group (n = 2,230) had a lower FEV1% predicted at index and a more rapid decline during the pre-index period. The mean rate of FEV1 decline improved for the dornase alfa group; the improvement was similar in adults and children 8-17 years old but was not statistically significant in adults. The comparator group (n = 5,970) showed no change among adults and an increased rate of decline among children 8-17 years old. Conclusions The use of dornase alfa for a 2-year period is associated with a reduction in the rate of FEV1 decline. These results also demonstrate the value of using an observational study to assess the association of instituting new therapies in the clinical setting with changes in the rate of FEV1 decline in patients with CF.

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