Inhaled drug boosts survival after lung transplant

Inhaling an anti-rejection drug, rather than swallowing it, can dramatically improve patients' chances of survival after lung transplants, a U.S. study says.

The drug involved, cyclosporine, is widely used to prevent organ rejection after transplant but is usually taken orally, the authors say.

Taking it by inhaler allows patients to get concentrations into their lungs that could only be achieved by oral doses strong enough to cause kidney damage, they say.

The study, published Wednesday in the New England Journal of Medicine, was done at the University of Pittsburgh between 1998 and 2001. It is described as the first double-blind, placebo-controlled trial ever conducted in lung transplant patients.

"Inhaled cyclosporine is the first drug ever to show a decline in the incidence of chronic rejection the leading cause of death following a lung transplant," the lead author, Aldo Iacono of the University of Maryland, said in a statement.

"In our study, the patients who took the inhaled cyclosporine had a two-thirds reduction in chronic rejection compared to those who had the placebo," he said.

Those given a placebo a dummy preparation with no active ingredient had a five times greater risk of death, adjusting for all other variables, he said.

"Our study shows for the first time that inhaled cyclosporine, taken in conjunction with oral anti-rejection medication, can protect patients from chronic rejection, which is the main reason that the average three-year survival rate from lung transplantation is only 55 percent a much lower rate than for other solid organ transplants, including liver and kidney transplants."

Co-author Bartley Griffith, also of the University of Maryland, said the results of the study are big news for transplant patients.

"Conventional anti-rejection drugs, which are given orally, do not get into the small air sacs of the lungs where chronic rejection takes place. It just makes a lot more sense to give a higher concentration of the drug right into the area you are trying to treat," he said.

The study involved 56 people who had received either a single or a double lung transplant. They were randomly assigned to take either inhaled cyclosporine or an inhalable placebo along with traditional anti-rejection therapy. They took the inhaled preparations at home three times a week.