In a surprising finding from the placebo versus active setting, an A.L.S. medication seems to extend life and reduce medical costs for patients, according to a new study at the University of California Los Angeles.
The findings, published in the American Journal of Respiratory and Critical Care Medicine, appeared to align with reports from other studies suggesting that A.L.S. — acute respiratory syncytial virus — may cause fewer hospitalizations than HIV and cancer treatments, said Dr. Daniel J. Warthen, a geriatrician, an associate professor of medicine and a senior author of the study. The most common A.L.S. attacks cause severe respiratory symptoms and death in a quarter to a third of patients.
The study, presented at the annual meeting of the American Thoracic Society in Atlanta, included 35 patients admitted to one of UCLA’s two A.L.S. units and randomly assigned to take the drug rifampin or an inactive saline placebo for five weeks. Both conditions were given in a place that looked and felt like a hospital, with a nurse’s view of patients and videos of patients to watch during their recovery. The measures of A.L.S. caused hospitalization rates for the patients ranged from 32 percent to 31 percent, after being adjusted for the death rate.
The drugs helped patients who were previously considered too sick for the therapy live about 30 days longer and a serious set of side effects, including chest tightness, nausea and chest pain, weren’t reported in any of the patients, the study authors said. It didn’t matter which patients received the medications.
“We weren’t blinded. We had to take a side, but we weren’t exposed to bias,” Dr. Warthen said. He said he did not know whether the treatments resulted in less A.L.S. cases, and the reason for that is not yet known. A.L.S. is the most common viral infection in adults, with 2.5 million people hospitalized annually for the illness, according to the Centers for Disease Control and Prevention. But unlike other germs, such as the common cold, it can be transmitted without showing symptoms or symptoms showing up in the first few days of illness. Rifampin, which was first developed as a treatment for post-operative infection, can inhibit the replication of the viruses.
In the study, patients completed online surveys assessing their health status before the start of the study and after using the drugs. Those receiving the medication had not previously had A.L.S. or a previous close encounter with the virus. About half of those hospitalized were in severe respiratory distress, either because of being sick with the virus or having undergone a surgical procedure with a risk of infection. Three patients had A.L.S. but no other infection.
One patient who’d never previously had A.L.S. was “a young guy in his 30s, who had never had anything reported as serious with his other health care,” Dr. Warthen said.
In earlier research, rifampin also appears to help chemotherapy patients who are otherwise considered unlikely to survive. A.L.S. patients don’t get the typical cancer drugs — chemotherapy doesn’t have the same immunosuppressive effects or causing onsets of A.L.S. that those drugs have on the body.
Dr. Andrew J. Leow, an epidemiologist at the University of Pittsburgh Medical Center who was not involved in the study, said, “What I do take from this study is, we have to remember that A.L.S. is a serious disease with a lot of complications and that serious treatment options exist for it.” A.L.S. typically begins in early childhood, but can cause problems from old age, including lung damage or death. About 2 percent of patients die within two months of their first symptoms, Dr. Warthen said. Most patients, although not all, will require a ventilator or other respiratory support during the second week of hospitalization, when the medication should work, the UCLA scientists concluded.
The drug, currently used to treat acute respiratory distress syndrome in terminally ill infants, is also sold to people who are short of breath after exercise, and he said rifampin is also widely used for breathing problems in intersex children and neonates with various immune deficiencies.