Anti-viral drug (injected into bloodstream) 'saved swine flu victim'

[Shiloh]

Source: http://www.irishtimes.com/newspaper/world/2009/0904/1224253821976.html

Friday, September 4, 2009
Anti-viral drug 'saved swine flu victim'

SARAH BOSELEY

DOCTORS SAVED the life of a 22-year-old woman who was critically ill with swine flu by experimentally giving her a high dose of an antiviral drug directly into her bloodstream, they reported yesterday.

Initial attempts to treat the woman with the oral drug Tamiflu and with the anti-viral, Relenza ? licensed for use only through an inhaler ? had little effect.

In the case study, published online by the Lancet medical journal, Dr Michael Kidd and Dr Mervyn Singer from University College London Hospitals call for studies to find out whether Relenza given intravenously could save more lives.

The patient, whose immune system had been compromised by chemotherapy to treat Hodgkin?s disease, was taken into intensive care on July 8th last. Tamiflu and antimicrobials failed to help her, and she was put on a ventilator.

Eight days of Relenza through a nebuliser did not work, so doctors were given permission by her relatives and the hospital to put the drug in an intravenous drip. They also gave her a corticosteroid to reduce lung inflammation.

Within 48 hours she had improved, with no drug-related side effects. Just over three weeks after her arrival in intensive care she was discharged. ? (Guardian service)

 

[Shiloh]

Re: Anti-viral drug (injected into bloodstream) 'saved swine flu victim'

Source: http://www.google.com/hostednews/afp/article/ALeqM5g8N7aFDz_XAVfgWthSJKuwBSP_uw

Unorthodox use of antiviral drug saved swine-flu victim's life

(AFP) ? 1 hour ago

PARIS ? Enterprising doctors saved the life of a young cancer patient infected by swine flu by making unlicensed use of Relenza, an antiviral drug, The Lancet reports on Friday.

The 22-year-old patient's immune system had been weakened by Hodgkin's disease and chemotherapy, damaging her defences against the A(H1N1) virus.

She was admitted in July to London's University College Hospital suffering from shortness of breath and fluid buildup in both lungs.

Neither Tamiflu, a pill that is the frontline treatment for swine flu, nor broad-spectrum antibiotics had any effect. By the third day, she was placed on an artificial respirator.

Doctors administered Relenza, also known by its lab name as zanamivir, in its licensed form as a nebulised spray.

But this remedy also failed and over the next two weeks she steadily worsened.

With her life in the balance, the doctors gambled on giving her Relenza intravenously, using a batch specially provided by the drug's manufacturers, GlaxoSmithKline.

They backed this with a high dose of corticosteroids to tackle lung inflammation.

Her condition improved dramatically and within 48 hours she was taken off artificial respiration and transferred out of the hospital's intensive care unit and into a general ward.

The unorthodox treatment had to be approved by the hospital's oversight committee and the patient's next of kin as it is not a recognised strategy for swine flu.

Most of the deaths from swine flu have been related to severe respiratory failure, especially from people with an underlying medical condition.

Physicians Michael Kidd and Mervyn Singer believe their patient's lungs were so impaired by the virus that she could not absorb Relenza in its spray form, so they took a final gamble on an intravenous drip.

Further investigation will confirm whether the treatment can find a wider use beyond a single case report, they said.

 

[Gert van der Hoek]

Re: Anti-viral drug (injected into bloodstream) 'saved swine flu victim'

Study: New treatment may combat drug-resistant flu

By MARIA CHENG (AP) ?

LONDON ? A new and unlicensed treatment for swine flu could be used in patients who have Tamiflu-resistant viruses, doctors say. In an article published Friday in the medical journal Lancet, British doctors describe how they used an intravenous form of the antiviral Relenza to treat a 22-year-old woman who had a severe case of swine flu. Relenza is usually inhaled via the nose, and is not licensed to be given intravenously.

The woman had recently undergone chemotherapy for Hodgkin's disease. After catching swine flu, her lungs filled with fluid and she was put on a ventilator to help her breathe. Despite days of being given Tamiflu, inhalable Relenza, and other medicines, the patient deteriorated.

So her doctors decided to try a different way of getting the drug into her body, since her lungs weren't able to absorb the antivirals the usual way.

After getting permission from her family and a hospital committee, they gave her an unlicensed, intravenous form of the antiviral zanamivir, or Relenza, provided by its maker, GlaxoSmithKline PLC. The patient recovered soon afterward, with no reported side effects.

"This may provide a third route to treat patients that are not responding to antiviral treatment because the active drug is not getting to the lungs," said Michael Kidd, of University College London, and the lead author of the study.
"Although we now know our patient did not have Tamiflu-resistant virus, the intravenous zanamivir could potentially be used to treat such a case," Kidd said.

The World Health Organization said the treatment was likely to be used only in rare circumstances, since it is not easily available and is unlicensed. But in patients with weak immune systems ? like those who have had chemotherapy or have diseases like HIV ? the treatment may be useful since they are at high risk of developing drug-resistant viruses.

"To change the antiviral being used is therefore a logical option in those cases," said Gregory Hartl, a WHO spokesman. Tamiflu is usually the first treatment for swine flu, though Relenza is occasionally used.

Only a handful of Tamiflu-resistant swine flu viruses have been picked up so far, but the virus could mutate into a resistant form the more it spreads. Widespread Tamiflu resistance has been seen in a seasonal strain of H1N1, distantly related to swine flu.

Countries which give out Tamiflu liberally, like Britain, might also speed up the emergence of resistant viruses.

Contrary to WHO recommendations, which suggests Tamiflu be saved for vulnerable groups like pregnant women and children, Britain gives out Tamiflu to anyone thought to have the virus.

Call center workers without any medical training at its national flu hot line gave out tens of thousands of doses of the drugs to otherwise healthy people who had swine flu this summer.

Kidd said the intravenous Relenza might also be useful to treat other severely ill patients with flu, and could potentially shorten their stay in the hospital. That might relieve the anticipated crush on hospital beds in the coming winter season, when swine flu is expected to rebound.

A similar case of using Relenza intravenously was reported in Australia in a patient who also survived a serious bout of swine flu.

Countries in the northern hemisphere are now making last-minute preparations for the imminent flu season, since a vaccine is not expected to be available before mid-October at the earliest.

Even though the swine flu virus is mild, the numbers of people who catch the virus ? WHO has estimated 2 billion people worldwide could be infected ? could overwhelm health systems.

On the Net:

http://www.lancet.com

http://www.google.com/hostednews/ap/article/ALeqM5jiu5_XIpOi5zq5q6ZrUoLrO2kc5wD9AG4MHG0