หัวหน้าหน่วยโรคภูมิแพ้ สถาบันสุขภาพเด็กแห่งชาติมหาราชินี ชมรมโรคระบบหายใจและเวชบำบัดวิกฤตในเด็กแห่งประเทศไทย ร่วมกับ ยูโรดรัก ลาบอราทอรีส์ พญ.มุกดา หวังวีรวงศ์ หัวหน้าหน่วยโรคภูมิแพ้ สถาบันสุขภาพเด็กแห่งชาติมหาราชินี

Doxofylline Last generation methylxanthine derivative for airway obstructions Markedly lower affinity for adenosine receptors As effective as the conventional methylxanthines being a bronchodilator with lower risk of adverse reactions

Doxofylline Shows favorable anti-inflammatory effects in the airways Retains the inhibitory action on PDE-4 due to its chemical structure (methylxanthine + dioxolane substitution) No need for monitoring plasma drug levels

Bagnato GF. Eur Review Med Pharma Sci 1999; 3:255-60. Tolerability of doxofylline in the maintenance therapy of pediatric patients with bronchial asthma 806 patients, aged 3-16 yo. Doxofylline (200mg sachets) 100-400 mg/d – 6 mg/kg/d q 12 hr More than one-half of the patients received 3 or more drugs Reported side-effects 11% - GI 76%, CNS 16%, palpitation 9% Bagnato GF. Eur Review Med Pharma Sci 1999; 3:255-60.

or Theophylline 300 mg b.i.d for 28 days Doxofylline-Clinical effecacy in reducing weekly salbutamol consumption In a multicentre,randomised trial on adult patient with COPD given either doxyfylline 400 mg b.i.d or Theophylline 300 mg b.i.d for 28 days Consumption of salbutamol Theophylline - 38% Doxofylline - 47% Doxofylline significantly decreased concurrent Salbutamol consumption

Doxofylline – Clinical efficacy Asthma: overall clinical data on 806 children(age 3-16,mean 8;61%≤10 yrs) % % Doxofylline efficacy favorable in 91% Doxofylline safety was favorable in 89% Bagnoto GF. Eur Rev Med Pharmacol Sci 2000, in press

Doxofylline Safety - Clinical 48 studies, 1056 subjects Total prevalence of side-effects : 15.2% Overall risk for any adverse event : 1.8 events per patient-year Total dropouts : 3% Treatment interruptions for any reason: 0.4 per patient-year

Conclusion Inhaled steroids are the most effective controller medications currently avaiable Multicenter study :- Theophylline serum conc. <10mcg/ml provided nearly as much effect as an inhaled steroids, beclomethasone, in controlling chronic asthma

Conclusion Sustained-release theophylline can be used as an alternative to inhaled steroids for maintenance therapy in mild persistent asthma Sustained-release theophylline can be added with a low dose inhaled steroids in asthma control

Conclusion Doxofylline is effective in the long-term treatment of obstructive pulmonary diseases It is safer and has greater therapeutic index than theophylline or aminophylline Can be used in children, elderly, patients with CVS,CNS and GI diseases

Conclusion There is no evidence that Doxofylline effectiveness or adverse events are related to blood levels As a consequence there is no need for continued measurements blood level during long-term treatment

ขอขอบคุณ บริษัทยูโรดรัก ลาบอราทอรีส์