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NUTRITIONAL IMPACT OF RECOMBINANT HUMAN DEOXYRIBONUCLEASE (rhDNase) IN CYSTIC FIBROSIS (CF) PATIENTS

1998; Lippincott Williams & Wilkins; Volume: 26; Issue: 5 Linguagem: Inglês

10.1097/00005176-199805000-00264

1536-4801

Nathalie Wizla‐Derambure, L. Michaud, A Sardet, A. Deschildre, Guy‐André Loeuille, E Tassin, N. Loire, C. Buisine, E. Boutry, F. Gottrand, Dominique Turck,

Infant Nutrition and Health

255 It has been shown that rhDnase improves lung function and reduces the incidence of pulmonary exacerbations in CF patients. However, very few data are available on the nutritional impact of rhDNase. The aim of this study was to evaluate the effect of rhDNase on nutritional status in CF patients during a 2-year follow-up. Patients and methods: From August 1994 to January 1995, rhDNase was started in 82 CF patients whatever their clinical condition, provided age≥5 years and forced vital capacity (FVC)≥40% predicted. The dose of rhDNase was 2.5 mg once daily. Thirteen patients were withdrawn for the following reasons: poor compliance (n=8) or intolerance to rhDNase (n=1), lung transplantation(n=1), lack of data (n=3). Baseline spirometric values (% predicted) and nutritional status of the 69 patients who completed the study (35 boys, 34 girls; mean age: 8.5 years; range: 5-16.4 years) were as follows: FVC: 84.8±21.7%; forced expiratory volume in 1 second (FEV1): 80.8±22.2%; Z score Weight/Height: -0.41±1.14; Z score Weight/Age: -0.48±1.25; Body Mass Index (BMI): 15.4±1.8; caloric intake: 107±25% of recommanded dietary allowances. Spirometric and nutritional data were analysed after 1, 3, 6, 12, 18 and 24 months of treatment and compared to baseline values. The number of oral and intravenous antibiotic courses and the Shwachman score were compared at baseline and after 2 years of treatment with rhDNase. No specific dietetic recommendations were given during the study period. Results: An improvement of lung function was observed after 1 month of treatment and was maintained throughout the following 2 years around 8.7%(6.4-11.4%) for FVC (p<0.01) and 8.2% (7.3-9.1%) for FEV1 (p<0.01). An increase in caloric intake was observed from the 3rd month (+ 6.3%, p<0.05) until the end of the 2nd year (+ 14.8%, p<0.01). During the year before the beginning of the study, a decrease of 8.3% in caloric intake had been observed. An increase of BMI was observed from the 6th month (15.7±1.7, p=0.02) until the end of the 2nd year (16.2±2.4, p<0.001). Z score Weight/Age increased significantly after only 3 months of treatment (+0.13, p<0.01) but gradually returned to baseline values thereafter whereas Z score Weight/Height only improved after 2 years (+0.19, p<0.05). Shwachman score remained unchanged after 2 years of treatment (89±10 vs 87±9 at baseline, NS) as well as the number of antibiotic courses/year(5.3±5.3 vs 5±5.8 at baseline, NS). Conclusion: In our population of CF patients with young age and mild to moderate lung disease, treatment with rhDNase was associated with an increase in caloric intake and an improvement of nutritional status. Nutritional impact of rhDNase is not related in our patients to a decrease of respiratory tract infections, the incidence of which remained stable during the study period.