Asthma Drug Avoids Steroids

An experimental, genetically engineered drug could offer asthma sufferers an entirely new treatment without the dangerous side effects of steroids, the standard medication for many patients, researchers say.

In a study reported in today's New England Journal of Medicine, about a quarter of the asthma patients on inhaled steroids were able to stop taking them after being given the new drug, rhuMAb-E25. And a third of those using oral steroids were able to quit, too.

Steroids have been widely used to treat moderate to severe asthma for the past decade. But long-term use stunts children's growth. In adults, steroids can cause osteoporosis, stomach bleeding, elevated blood pressure and blood sugar, cataracts and weight gain.

RhuMAb-E25 is an intravenous drug made by splicing a tiny segment of a cloned mouse gene into a human antibody. After further testing, the three companies developing it--Genentech, Novartis Pharma AG and Tanox--hope to seek Food and Drug Administration approval for its sale in about six months. Genentech funded the study.

In an asthma attack, hypersensitive airways narrow drastically when exposed to an allergen, such as cigarette smoke, pet dander, pollen, feathers and mites. A type of antibody called IgE prompts immune cells to release histamines in a misguided attempt to neutralize the allergens. Instead, the histamines inflame and further narrow the airways. RhuMAb-E25 binds up more than 95 percent of the IgE, averting the release of much of the histamines.

Support for Arterial Stents

For years, heart specialists have debated whether it is wise to use mesh tubes called stents to keep heart arteries open after they have been expanded with an inflatable balloon. Two studies reported in today's New England Journal of Medicine suggest the answer is a qualified "yes." The tubes are effective at keeping the arteries open, the studies conclude, but there is still no evidence that the stents help heart disease patients live longer.

Used for less than a decade, stents are now implanted in up to 70 percent of heart disease sufferers who undergo angioplasty, a procedure in which a balloon is threaded into the heart at a point where heart disease has narrowed an artery. When the balloon is expanded, it usually reopens the blood vessel.

In one study of 900 volunteers who had suffered a heart attack and were treated with angioplasty, doctors found that 11 percent of the stent recipients suffered chest pain after six months, compared with 17 percent of those who did not get stents. While blood vessels narrowed in 34 percent of those who did not get a stent, the rate was 20 percent for those who did.

However, the study--led by Cindy L. Grines of William Beaumont Hospital in Royal Oak, Mich.--found that the death rate after six months was 4.2 percent for stent recipients, compared with 2.7 percent for patients who did not get them.

That is not statistically significant. But researchers had hoped the study would show that stent use dramatically reduces mortality.

The second study, a statistical analysis of cases in British Columbia, also noted that heart vessels have tended to stay open longer as the use of stents has increased.