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doi:10.1378/chest.06-2282
(Chest. 2007; 131:788-795)
© 2007 American College of Chest Physicians
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Recombinant Human Deoxyribonuclease in Infants With Respiratory Syncytial Virus Bronchiolitis*

Ruben Boogaard, MD; Anthon R. Hulsmann, MD, PhD; Leoniek van Veen, MD; Anja A. P. H. Vaessen-Verberne, MD, PhD; Yen Ni Yap, MD; Arwen J. Sprij, MD; Govert Brinkhorst, MD; Barbara Sibbles, MD; Tom Hendriks, MD; Sander W. W. Feith, MD; Carsten R. Lincke, MD, PhD; Annelies E. Brandsma, MD, PhD; Paul L. P. Brand, MD, PhD; Wim C. J. Hop, PhD; Matthijs de Hoog, MD, PhD and Peter J. F. M. Merkus, MD, PhD

* From the Department of Pediatric Pulmonology (Drs. Boogaard and Merkus), Erasmus MC-Sophia Children’s Hospital, Rotterdam; Department of Pediatrics (Drs. Hulsmann and Vaessen-Verberne), Amphia Hospital, Breda; Reinier de Graaf Gasthuis (Dr. van Veen), Delft; Albert Schweitzer Hospital (Dr. Yap), Dordrecht; HagaTeaching Hospital/Juliana Children’s Hospital (Dr. Sprij), the Hague; Medisch Centrum Alkmaar (Dr. Brinkhorst), Alkmaar; Erasmus MC-Sophia Children’s Hospital (Drs. Sibbles and de Hoog), Rotterdam; Catharina Hospital (Dr. Hendricks), Eindhoven; Sint Franciscus Gasthuis (Dr. Feith), Rotterdam; Medisch Centrum Rijnmond Zuid (Drs. Lincke and Brandsma), Rotterdam; Isala Klinieken (Dr. Brand), Zwolle; and De-partment of Epidemiology and Biostatistics (Dr. Hop), Erasmus MC, Rotterdam, the Netherlands.

Correspondence to: Ruben Boogaard, MD, Room Sb-2666, Department of Pediatric Pulmonology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, PO Box 2060; 3000 CB Rotterdam, the Netherlands; e-mail: r.boogaard{at}erasmusmc.nl

Abstract

Background: Treatment of hospitalized infants with respiratory syncytial virus (RSV) bronchiolitis is mainly supportive. Bronchodilators and systemic steroids are often used but do not reduce the length of hospital stay. Because hypoxia and airways obstruction develop secondary to viscous mucus in infants with RSV bronchiolitis, and because free DNA is present in RSV mucus, we tested the efficacy of the mucolytic drug recombinant human deoxyribonuclease (rhDNase).

Methods: In a multicenter, randomized, double-blind, controlled clinical trial, 225 oxygen-dependent infants admitted to the hospital for RSV bronchiolitis were randomly assigned to receive 2.5 mg bid of nebulized rhDNase or placebo until discharge. The primary end point was length of hospital stay. Secondary end points were duration of supplemental oxygen, improvement in symptom score, and number of intensive care admissions.

Results: There were no significant differences between the groups with regard to the length of hospital stay (p = 0.19) or the duration of supplemental oxygen (p = 0.07). The ratio (rhDNase/placebo) of geometric means of length of stay was 1.12 (95% confidence interval, 0.96 to 1.33); for the duration of supplemental oxygen, the ratio was 1.28 (95% confidence interval, 0.97 to 1.68). There were no significant differences in the rate of improvement of the symptom score or in the number of intensive care admissions.

Conclusions: Administration of rhDNase did not reduce the length of hospital stay or the duration of supplemental oxygen in oxygen-dependent infants with RSV bronchiolitis.

Key Words: controlled clinical trial • dornase alfa • pediatric respiratory syncytial virus bronchiolitis • treatment






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