A new study finds that a
higher than expected number of COPD and severe asthma patients had abnormal
low levels of alpha-1 antitrypsin (AAT), suggesting the need for broader
criteria for AAT deficiency testing. AAT deficiency, also known as Alpha-1,
is a widely undiagnosed hereditary disorder that is usually fatal in its
severe form.
Alpha-1 is estimated to affect up to 100,000 Americans, but up to 95
percent are undiagnosed or have been misdiagnosed as having another form of
chronic obstructive pulmonary disorder (COPD). Details of the study were
presented at CHEST, the annual meeting of the American College of Chest
Physicians held in Chicago from October 20 to 25. Study results are being
announced on World COPD Day to focus attention on the need for wider
testing for AAT deficiency.
"Findings from this study suggest that simply all patients with
moderate or severe persistent asthma and/or COPD with chronic pulmonary
symptoms should be tested for AAT deficiency," said Gary Rachelefsky, MD,
Professor of Allergy and Immunology and Director of the Executive Care
Center for Asthma, Allergy and Respiratory Diseases at UCLA School of
Medicine and study investigator. "It is imperative that clinicians become
more vigilant about Alpha-1 testing as many patients are going undiagnosed
or misdiagnosed due to screening criteria and practices."
The study, conducted by the Respiratory & Allergic Disease Foundation,
recruited 40 office based pulmonologists across the United States who
tested 454 adult patients using the following simple screening criteria:
persistent asthma and/or COPD patients with loss of lung function defined
by either a FEV1 (forced expiratory volume at 1 second) or a ratio of FEV1
to forced vital capacity (FEV1/FVC) of less than 70 percent. Blood tests
were taken to assess levels of AAT, and additional lab results and patient
histories were noted and tabulated.
Of the 454 patients studied, 3.3 percent showed deficient levels of
AAT. Low blood levels of AAT are commonly associated with progressive
severe emphysema that becomes clinically evident by the third to fourth
decade of life; a recent registry showed that 54 percent of AAT deficient
patients had emphysema. Less commonly, low levels of AAT are associated
with liver disease and cirrhosis.
Interestingly, patients who tested with low AAT did not significantly
differ from the COPD/persistent asthma patients with normal levels of AAT
in several key pulmonary function criteria, including levels of FEV1,
ratios of FEV1 to forced vital capacity (FEV1/FVC), or the number of
bronchial infections within the past 12 months. This lack of
differentiating characteristics in deficient subjects indicates that if
pulmonologists rely on standard screening criteria for Alpha-1 testing, the
result will be incorrect and missed diagnoses.
"Our surveillance study found that physicians cannot depend on typical
patient profiles to assess whether AAT deficiency screening is necessary.
There is no 'face' to AAT deficiency," said D. Kyle Hogarth, MD, FCCP,
Assistant Professor of Medicine, University Chicago Medical Center,
Director of the Alpha-1 Antitrypsin Deficiency Clinical Resource Center at
the University of Chicago and lead author of the study. "A number of
patients who would not normally be screened based on suggested guidelines
turned out in fact to be positive for AAT deficiency. In the real-world
setting, this suggests that thousands of patients who have been diagnosed
with COPD or severe asthma may actually have Alpha-1."
The RAD study was supported by an unrestricted educational grant from
CSL Behring, maker of the Alpha1 Proteinase Inhibitor (Human), Zemaira(R).
About Alpha-1 Antitrypsin Deficiency (Alpha-1)
Alpha-1 antitrypsin is an anti-inflammatory protein that protects the
tissue of the body. One of its most important roles is to shield the
delicate tissues of the lungs by binding to neutrophil elastase, an enzyme
released by certain white blood cells that digests bacteria and other
foreign substances in the lungs. When a person with deficient levels of AAT
inhales irritants or contracts a lung infection, the neutrophil elastase
released to protect the lungs is uncontrolled and can injure healthy lung
tissue. Repeated injury to the normal structure of the lungs can eventually
result in emphysema, a condition affecting 54 percent of diagnosed AAT
deficient patients, according to a recent registry. Identifying patients
with AAT deficiency can be problematic, however. Because AAT deficiency
typically involves such common symptoms as shortness of breath on exertion,
wheezing, and coughing, the condition is often misdiagnosed as another
chronic lung condition. In fact, retrospective studies show that even after
an Alpha-1 patient has developed symptoms, it can take an average of seven
years and visits to five different healthcare professionals before the
correct diagnosis is made. Researchers estimate that up to 100,000 adults
and children in the U.S. have severe Alpha- 1, and 25 million people
nationwide may be carriers. Only about 5,000 patients are currently
diagnosed as AAT deficient, meaning that up to 95 percent of people with
the deficiency remain undiagnosed.
CSL Behring to Launch National Campaign to Improve Detection of AAT
Deficiency
To advance the early diagnosis and treatment of AAT deficiency, CSL
Behring, a leader in alpha-1 research and treatment, is launching a
national education and support program called Test Today. Change Tomorrow.
The initiative will target patients, caregivers and healthcare
professionals with activities and services, such as a national disease
awareness campaign about Alpha-1 deficiency, a toll-free information center
and website, educational materials, and a program to support Alpha-1
testing in healthcare settings, called Champions for Alpha-1 Testing. Test
Today. Change Tomorrow. will begin the week of November 18 with the launch
of a national television show as part of the series Today's Health.
CSL Behring is the maker of Alpha1-Proteinase Inhibitor (Human),
Zemaira(R), which is indicated for chronic augmentation and maintenance
therapy for individuals with established AAT deficiency and clinical
evidence of emphysema. Zemaira(R) is not indicated as therapy for lung
disease patients in whom severe congenital A1-PI deficiency has not been
established. Clinical data demonstrating the long-term effects of chronic
augmentation therapy with Zemaira are not available.
As with other Alpha-1 therapies, Zemaira may not be appropriate for the
following adult individuals as they may experience severe reactions,
including anaphylaxis: individuals with a known hypersensitivity and/or
history of anaphylaxis or severe systemic reaction to Alpha-1 Proteinase
Inhibitor products or their components and individuals with selective IgA
deficiencies who have known antibodies against IgA.
In clinical studies, the following treatment-related adverse reactions
were reported in 1 percent of subjects: asthenia (fatigue), injection-site
pain, dizziness, headache, paresthesia (tingling) and pruritus (itching).
Zemaira is derived from human plasma. As with all plasma-derived products,
the risk of transmission of infectious agents, including viruses and,
theoretically, the Creutzfeldt-Jakob disease (CJD) agent, cannot be
completely eliminated.
About CSL Behring
CSL Behring is a global leader in the plasma protein biotherapeutics
industry. Passionate about improving the quality of patients' lives, CSL
Behring manufactures and markets a range of safe and effective
plasma-derived and recombinant products and related services. The company's
therapies are used in the treatment of immune deficiency disorders,
hemophilia, von Willebrand disease, other bleeding disorders and inherited
emphysema. Other products are used for the prevention of hemolytic diseases
in the newborn, in cardiac surgery, organ transplantation and in the
treatment of burns. The company also operates one of the world's largest
plasma collection networks, ZLB Plasma. CSL Behring is a subsidiary of CSL
Limited, a biopharmaceutical company with headquarters in Melbourne,
Australia. For more information, visit cslbehring.
About the Respiratory & Allergic Disease Foundation
The Respiratory & Allergic Disease Foundation (RAD) is a physician-led
501(c)(3) non-profit corporation that provides education for patients and
clinicians on allergic and respiratory diseases that affect millions of
people in the United States. As new approaches evolve for the treatment of
respiratory and allergic diseases, RAD is committed to developing
scientific and educational programs for healthcare professionals that
incorporate the latest developments in understanding and treating these
conditions. With the assistance of our world-class steering committee,
network of faculty and participants across the United States, RAD provides
healthcare professionals with the cutting-edge, practical education needed
to move respiratory medicine forward. Learn more at rad-foundation.
CSL Behring
cslbehring
View drug information on Zemaira.
Комментариев нет:
Отправить комментарий