Scientific Poster Session II - Original Research

Original Research
  Sunday, November 12, 2023
  12:45 PM–02:15 PM

Abstract

Introduction:
Dornase alfa is only FDA-approved in patients with cystic fibrosis (CF) as a mucolytic agent, but there is limited evidence for its use to treat pulmonary atelectasis (PA) in patients without. There are currently no FDA-approved medications for PA.

Research Question or Hypothesis:
To describe the use, clinical outcomes, and adverse effects of dornase alfa in pediatric patients

Study Design:
This was a single-center, retrospective cohort study of patients who received at least one nebulized dose of dornase alfa between January 1, 2019 and December 31, 2020 at a quaternary care pediatric hospital.

Methods:
Manual chart review was completed to record data in RedCap database. The primary outcome was to characterize use of dornase alfa and concomitant use of other inhaled medications. The secondary outcomes were changes in i) fraction of inspired oxygen (FiO2), ii) presence of atelectasis on x-rays, and iii) presence of polymorphonuclear neutrophils (PMNs) in respiratory cultures following dornase alfa initiation.

Results:
This study included 123 patients with 229 dornase alfa orders. The majority of orders had once daily (45%) or twice daily dosing frequencies (45%). Most orders were used for non-CF indications (84%), and 50% of orders were used for atelectasis. The pediatric pulmonology team recommended 24% of orders. Other inhaled medications were ordered before dornase alfa initiation in 67% of orders. FiO2 was reduced at 24 hours after dornase alfa initiation compared to the baseline (50 [35-70] vs 45 [30-60], P <0.05); however, no change in FiO2 was seen after the first 24 hours of use. There were no differences between baseline, 24 hours, 48 hours, and 72 hours after dornase initiation with regards to atelectasis on x-ray, and the presence and quantity of PMNs on respiratory cultures.

Conclusion:
The use of dornase alfa orders did not show statistically significant improvement in clinical outcomes except for FiO2 decrease 24 hours after dornase alfa initiation.

Presenting Author

Aniqa Azad BA
UCSF

Authors

Jiyong Ahn PharmD
UCSF

Lulu Jin PharmD, BCPPS, BCPS
UCSF

Wesley Nguyen PharmD
University of California, San Francisco

Joshua Chin PharmD
UCSF

Joshua Robinson PharmD, APh, BCCCP
UCSF