พญ.มุกดา หวังวีรวงศ์ หัวหน้าหน่วยโรคภูมิแพ้ สถาบันสุขภาพเด็กแห่งชาติมหาราชินี

1. ชมรมโรคระบบหายใจและเวชบำบัดวิกฤตในเด็กแห่งประเทศไทยชมรมโรคระบบหายใจและเวชบำบัดวิกฤตในเด็กแห่งประเทศไทย ร่วมกับ ยูโรดรัก ลาบอราทอรีส์ พญ.มุกดา หวังวีรวงศ์ หัวหน้าหน่วยโรคภูมิแพ้ สถาบันสุขภาพเด็กแห่งชาติมหาราชินี

2. 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

3. 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

4. Tolerability of doxofylline in the maintenance therapy of pediatric patients with bronchialasthma • 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.

5. Doxofylline-Clinical effecacyin 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

6. 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

7. 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

8. 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 chronicasthma

9. 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

10. 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

11. 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

12. ขอขอบคุณ บริษัทยูโรดรัก ลาบอราทอรีส์