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DG DISPATCH - ACEP: Accolate May Decrease Need For Hospital Visits By Andrew Bowser Special to DG News LAS VEGAS, NV -- October 12, 1999 -- Accolate® (zafirlukast) may have a role in the treatment of acute asthma beyond its current role as a controller agent in chronic asthma, suggests research presented at American College of Emergency Physicians (ACEP) Scientific Assembly and Research Forum. In a randomized, double-blind, placebo-controlled study including 641 patients, investigators showed that this oral leukotriene receptor antagonist, in a single dose of 160 mg or 20 mg, improved pulmonary function when administered to a patient presenting to the emergency department with an acute asthma attack. The higher dose of zafirlukast, which in chronic asthma improves pulmonary function and symptoms while decreasing the need for rescue agents, also produced a significant improvement in dyspnea versus placebo (68 percent versus 58 percent, p = 0.005). The study, which was funded and supported by AstraZeneca, included mostly African-American patients of whom approximately 36 percent were taking inhaled steroids prior to emergency department arrival. Forced expiratory volume (FEV1) was approximately 37 percent, suggesting a moderate-to-severe asthma population. By the end of the study protocol, FEV1 had improved by about 39 percent in both the low- and high-dose zafirlukast groups, compared with an improvement of 31 percent for the placebo-treated patients. From a cost and utilization perspective, only 10 percent of patients randomized to zafirlukast were admitted to the hospital, compared with 15 percent of patients in the placebo group (p = 0.052), for a relative 34 percent reduction in admissions. That findings suggested that 160 mg zafirlukast may decrease hospitalizations or further emergency department observations, but investigators are holding off on a more definitive statement for now. "Relapse data will be presented in the future, and at that point, I will remove the ‘may’ without hesitation," said Dr. Robert A. Silverman of Long Island Jewish Medical Center, New Hyde Park, New York, New York, USA. The findings could be significant, especially for emergency physicians, who deal with more than 1.8 million acute asthma visits annually, leading to nearly 500,000 hospitalizations; the problem costs more than US$6 billion per year, half of which is spent on inpatient costs. Related Links: Accolate and AstraZeneca. E-mail this page to a friend or colleague! To print, use this version