Therapeutic effect of lipoprostaglandin E1 on sudden hearing loss

PURPOSE

The authors conducted a prospective, comparative clinical trial for the purpose of additional effect of lipoprostaglandin E 1 (lipo-PGE 1 ) on sudden hearing loss.

MATERIALS AND METHODS

With the approval of the institute ethics committee, a total of 128 consecutive patients with diagnoses of sudden hearing loss were included in the study. The patients in the lipo-PGE 1 group received continuous infusion of 10 microL lipo-PGE 1 and 48 mg methylprednisolone for 5 days, and the patient in the control group were treated with only 48 mg methylprednisolone.

RESULTS

The total recovery rate after the treatment was 67.2%. There were 70.5% recovery rate in lipo-PGE 1 group and 60.5% recovery rate in control group. However, no significant differences were observed in the improvements of pure tone average and subjective symptoms between the lipo-PGE 1 and control groups.

CONCLUSION

The results failed to prove a beneficial effect of lipo-PGE 1 in the treatment of sudden hearing loss in spite of its higher cure rate.

Randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of AS-013, a prostaglandin E1 prodrug, in patients with intermittent claudication

BACKGROUND

Intermittent claudication due to peripheral arterial occlusive disease (PAOD) is a common cause of pain and disability in the middle-aged. Clinical trials of the potent vasodilator prostaglandin E1 have been disappointing. This is the first report of a controlled clinical trial of AS-0:3, a novel prodrug of prostaglandin E1 incorporated into lipid microspheres that has been developed to improve delivery of the active compound to blood vessel walls.

METHODS AND RESULTS

Eighty patients with stenosis or occlusion, symptoms of intermittent claudication, and maximum walking distance of > or = 30 and < or = 300 m on a standard treadmill test were randomized to placebo or one of three dosage regimens of AS-013. Drug was administered by intravenous injection 5 d/wk for 4 weeks. Treadmill tests and other assessments were completed at weeks 0, 4, and 8. A statistically significant increase in maximum walking distance was observed at 4 weeks (for placebo: median, 4.5 m; interquartile range [IQR], 20; for active treatment: median, 28.0 m; IQR, 81; P < .01, Mann-Whitney test). A similar response was seen at 8 weeks (for placebo; median, -11.2 m; IQR, 35; for active treatment: median, 35 m; IQR, 68; P < .01, Mann-Whitney test). Dose-related improvements in pain-free walking distance and quality of life were observed. No serious safety issues were noted.

CONCLUSIONS

These promising clinical data indicate that AS-013, a new prodrug of prostaglandin E1, could provide an effective and acceptable treatment for patients with intermittent claudication. Studies to investigate the optimal dosing regimen, duration of clinical benefit, and effects in more severe forms of peripheral arterial disease are warranted.

Aneurysmal dilatation of ductus arteriosus during lipo-prostaglandin E1 therapy for diaphragmatic hernia

We report a case of congenital diaphragmatic hernia in which aneurysmal dilatation of ductus arteriosus developed after lipo-prostaglandin E1 (PGE1) therapy for persistent fetal circulation. After surgery Lipo-PGE1 was used at a dosage of 5 ng/kg per minute from days 2-9 during which aneurysmal dilatation (7 mm in diameter) developed and remained thereafter. Ductus arteriosus ligation was then performed. Lipo-PGE1 may promote ductus arteriosus dilatation in cases of persistent fetal circulation.

Distribution of lipid microspheres incorporating prostaglandin E1 to vascular lesions

The intravascular distribution of 0.2 mu lipid microspheres (LM) containing prostaglandin E1 (lipo-PGE1) injected intravenously in spontaneously hypertensive rats (SHR) and arteriosclerotic rabbits was investigated by electron microscopic observation and quantification of radiolabelled compounds. LM were observed under an electron microscope to concentrate in subendothelial space of vascular walls, particularly in vascular lesions associated with hypertension or arteriosclerosis. Radiolabelled lipo-PGE1 accumulated more densely in the vascular walls than did free PGE1, and the difference was more conspicuous in vascular lesions. This indicates that lipo-PGE1 penetrates vascular endothelium and then accumulates in blood vessels to result in augmentation of the pharmacological action of prostaglandin. These findings suggest the usefulness of LM as a carrier of prostaglandin to vascular lesions.

A preliminary double-blind cross-over trial of lipo-PGI2, a prostacyclin derivative incorporated in lipid microspheres, in cerebral infarction

Lipo-PGI2 is a drug preparation of a PGI2 analogue (isocarbacyclin methylester) which is incorporated into lipid microspheres with a diameter of 0.2 mu. Lipo-PGI2 has been shown to accumulate at the vascular wall, particularly those of arteriosclerotic lesions, and it has a much stronger inhibitory activity on platelet aggregation than free isocarbacyclin. In this study, a preliminary double-blind cross over trial of lipo-PGI2 in cerebral infarction was carried out. Seventeen patients with chronic cerebral infarction received 2 micrograms of lipo-PGI2 and placebo daily for one week each in a cross-over double blind test. A significant improvement was noted for lipo-PGI2 compared with placebo in the overall improvement in neurological and mental symptoms (p less than 0.01). The patient's preference also indicated the effectiveness of lipo-PGI2 (p less than 0.05). Adverse reactions were noted in 3 patients receiving placebo, but not in any receiving lipo-PGI2. These results show that lipo-PGI2 at a very low dose would be beneficial as a treatment for relieving the clinical symptoms of chronic cerebral infarction and that lipid microspheres are a useful drug carrier for PGI2 analogue therapy.