Experimental drug might save critical swine flu victim

[dr kockosh]

Experimental drug helps save critical swine flu victim


<!-- // .article-tools -->GRANT McARTHUR
August 19, 2009 12:01am

<!-- // .content-row clearfloat --><!-- Article body -->GIVEN virtually no hope of survival, Ivan Luong has stunned doctors after recovering from swine flu with the help of a world-first experimental drug.
As the 20-year-old left intensive care last night following a marathon 38 days ? including 31 on breathing machines ? a team from Melbourne's The Austin hospital were still coming to terms with how they had saved the chronic asthmatic.
After arriving at the hospital on July 10, Mr Luong's lungs became so full of mucus they were almost solid, going from about 200g to more than 1kg and having no chance of passing oxygen into his blood.
Efforts to sustain him on traditional ventilators literally blew Mr Luong's lungs apart - causing air to fill his chest cavity and place pressure on his heart as well as dangerous pockets of air under his skin.
CLICK HERE TO GO TO SA HEALTH'S SWINE FLU FACTS PAGE
As his condition worsened an examination of the student's stomach revealed it had shut down, meaning the Tamiflu needed to fight off swine flu could not be digested.
With an intravenous drip the only way of getting medication into Mr Luong, the team decided to try a liquid form of flu drug Relenza ? a highly experimental formula not registered anywhere in the world, which had to be flown in from the U.S. where it had been produced for clinical trials unrelated to swine flu.
A relieved Mr Luong was yesterday coming to terms with enormous effort made to save his life. "All I can remember is getting needles about 40 days ago," he said.
"I have strong parents that love me and have prayed for me."
In Adelaide yesterday, a Hove man, 37, suffering from swine flu with no underlying medical conditions died, becoming the 11th death in South Australia.

 

[HenryN]

Re: Experimental drug helps save critical swine flu victim

Re: Experimental drug helps save critical swine flu victim

IV Relenza was tried on the immunosupressed patient in Seatle with Tamiflu resistant H1N1. They also tried IV Ribovirin. She's still in the hospital.

 

[dr kockosh]

Re: Experimental drug helps save critical swine flu victim

Re: Experimental drug helps save critical swine flu victim

IV Relenza was tried on the immunosupressed patient in Seatle with Tamiflu resistant H1N1. They also tried IV Ribovirin. She's still in the hospital.

Incredible that this guy pulled thru with this drug administered so late in the piece. It's obvious why antivirals work best in the early phase of flu replication - but i wonder what the mechanism is that has made such a dramatic difference this late.

 

[dr kockosh]

Re: Experimental drug helps save critical swine flu victim

Re: Experimental drug helps save critical swine flu victim

anyone know what the non flu tests for iv relenza were?

 

[mixin]

Re: Experimental drug helps save critical swine flu victim

Re: Experimental drug helps save critical swine flu victim

There is a discussion about IV zanamivir from the pandemic workshop. Here's part of it:

The IV form of zanamivir has been available since the early 1990s. Concern about pandemic influenza spurred interest from public health authorities in an injectable antiviral. IV-zanamivir provides high systemic exposure and addresses oseltamivir resistance. Initially, the product was proposed for pandemic preparedness only on the basis of animal data. Then, FDA asked GSK for studies on IV-zanamivir for severe seasonal influenza. Regulatory requirements evolved from providing a safety database with some evidence of efficacy from several small studies in 300–600 patients, to a superiority trial in more than 1200 patients. GSK’s feasibility studies showed that the latter trial would take at least 10 years to conduct. GSK and FDA acknowledged that some compromise must be made.
snip
Following its meeting with FDA, and after reviewing the recent FDA draft guidance, specifically the guidance on clinical trial design in severe hospitalized patients, GSK sees no feasible path to registration; therefore IV-zanamivir remains on hold. GSK will consider a clinical development proposal from a third party for influenza antiviral drug development if it includes a clinical development plan that is reasonable, feasible, scientifically robust, and likely to lead to registration and approval. If the clinical development plan does not meet these criteria, GSK would not support a trial, execute the trial, or provide the drug. However, GSK would not prohibit a third party from sourcing the product from another licensed manufacturer.

I think this is the correct link. Page 71
http://www.hhs.gov/aspr/conferences/nbsb/nbsb-h1n1forum-sum-090617.pdf

 

[DrRugby]

Re: Experimental drug helps save critical swine flu victim

Re: Experimental drug helps save critical swine flu victim

That is ultimately the same death for alternative critical care treatments where the numbers are too few except during pandemics.

Add this one to your tool kit.
High dose IV steroids. My favorite is solumedrol 250 mg for an adult along with copious IV normal saline hydration. Remember what kills the flu patient is not the influenza virus. It IS the body's immune response. That is whats causes the ARDS death cycle.

Got to hit it hard with steroids early especially in at risk groups like asthma, pregnant and diabetics (course one does have to adapt for glucose control).

I have had at least 5 patients, in the last 2 months, arrive looking like there was no way to avoid an admission, yet they walked out to go home. Have to be rechecked each day to watch for serious needs for aggressive respiratory treatments.

How to tell if it is not bacterial pneumonia? PROCALCITONIN. Low or normal? It is not a significant bacterial infection.

The pediatrician intensivists did the work over the last 10 years and a project just presented in Paris in May, 09, it has been proven in a controlled study of ICU patients.

 

[St Michael]

Re: Experimental drug helps save critical swine flu victim

Re: Experimental drug helps save critical swine flu victim

High dose IV steroids. My favorite is solumedrol 250 mg for an adult along with copious IV normal saline hydration. Remember what kills the flu patient is not the influenza virus. It IS the body's immune response. That is whats causes the ARDS death cycle.

...

The pediatrician intensivists did the work over the last 10 years and a project just presented in Paris in May, 09, it has been proven in a controlled study of ICU patients.

During the H5N1 crises, a lot of medical journals related evidence that high dose corticosteroids were counterproductive:

The Critically Ill Avian Influenza A (H5N1) Patient: Corticosteroid Therapy

Effect of dexamethasone on acute respiratory distress syndrome induced by the H5N1 virus in mice

According to the recent CDC report, Intensive-Care Patients With Severe Novel Influenza A (H1N1) Virus Infection --- Michigan, June 2009

Although five patients in this case-series received corticosteroids, their role in the management of severely ill patients with novel influenza A (H1N1) virus infection is unclear, and routine corticosteroid use is not recommended.

Could you post more data about the research presented in Paris in May, 09 that you are referencing?

 

[dr kockosh]

Re: Experimental drug helps save critical swine flu victim

Re: Experimental drug helps save critical swine flu victim

Thanks Mixin
Anyone know what the non flu tests for iv relenza were?

 

[mixin]

Re: Experimental drug might save critical swine flu victim

Your article said clinical trials unrelated to "swine" flu (not flu in general). I haven't seen any mention of trials being conducted for something other than pandemic preparedness but I could very well have missed seeing it. Possibly the trials were for H5N1?

 

[DrRugby]

Re: Experimental drug might save critical swine flu victim

Regarding steroids and H5, the comments upon their usage must have come from some less well informed. If one waits until the patient is intubated to give steroids then it may well be too late.

This string reminds me of the academic siezures occuring over the use or sera or fresh frozen plasma.

To not use these invaluable tools would be, from my point of view, malpractice.
Eitpher you are well versed in the life saving techniques or you should not pretent. Similar if you will to not having been trained in Advanced Cardiac Life Support and pretenting to run an emergency dept.

 

[St Michael]

Re: Experimental drug might save critical swine flu victim

Regarding steroids and H5, the comments upon their usage must have come from some less well informed. If one waits until the patient is intubated to give steroids then it may well be too late.

Google Scholar is far from perfect, nevertheless it is available to the general public. Google scholar search results, 2004 to present:

corticosteroids+H5N1

corticosteroids+H1N1

corticosteroids+ARDS

corticosteroids+SARS

corticosteroids+septic shock

Could you post some specific data about the research presented in Paris in May, 09 that you are referencing?