Therapeutics and Drugs Briefs

Roxithromycin in Non-Q-Wave MI

Source: Gurfinkel E, et al. Lancet 1997;350:404-407.

Substantial circumstantial evidence implicates Chlamydia pneumoniae in sequelae of coronary artery disease. High titers of C. pneumoniae antibody correlate with coronary heart disease, and atherosclerotic plaques themselves may demonstrate the organism. There is some suggestion that C. pneumoniae affects plaque stability, as well as atherogenesis.

The authors tested the hypothesis that treatment with an anti-chlamydial antibiotic would reduce clinical end points in patients with unstable angina and non-Q-wave MI. In a double-blind, randomized, placebo-controlled pilot study, 202 patients were assigned either roxithromycin or placebo, in addition to conventional therapy. Roxithromycin (U.S. trade name Dynabac) is similar to azithromycin (Zithromax) and clarithromycin (Biaxin) and is the most widely prescribed non-erythromycin macrolide in a number of European nations. Treatment, which included heparin and aspirin, was continued for 30 days, and follow-up continued for six months.

The primary composite triple end point (rate of severe recurrent ischemia, MI, and ischemic death) was substantially lower in the treatment group (1.1%, 0%, 0%) than in the placebo group (5.4%, 2.2%, 2.2%; P < 0.05). There were no serious drug-related adverse events. The mechanism by which roxithromycin exerts its effects remains speculative, but possible suppression of chronic C. pneumoniae infection within atherosclerotic plaque, or independent anti-inflammatory activity of the drug may play a role.

Nasal Sprays for Allergic Rhinitis

Source: Small P, et al. J Allergy Clin Immunol 1997;100:592-595.

Nasal steroids are a mainstay of treatment for allergic rhinitis. Mechanisms of symptom relief include vasoconstriction, decreased membrane permeability, and blunted immune responses. Of the available steroids, no clear guidance exists to provide rationale for use of one agent over another, save the standard issues of cost, dose frequency, and cosmetic issues like fragrance or after-taste. This study compared two popular once-daily nasal steroids, triamcinolone acetonide vs. fluticasone propionate, in 233 spring allergic rhinitis patients. Outcome measurements included rhinorrhea, nasal congestion, sneezing, and itching and a composite of all four symptoms at baseline and three weeks later.

Both products were equally efficacious in individual symptom reduction as well as composite scores. Modest, statistically significant side-effect profile differences were detected between the products. Triamcinolone was significantly less likely to be reported as running down the throat or out of the nose. On the other hand, fluticasone was less likely to cause dry nostril sensation or a sensation of a stuffed-up nose.

Triamcinolone and fluticasone are equally efficacious in symptom control of allergic rhinitis.