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FORMULARY FORUM

Aralast: A New ₁-Protease Inhibitor for Treatment of -Antitrypsin Deficiency

Associate Professor, Department of Pharmacy, University of Southern California, Los Angeles, CA

David Alexander Sclar, PhD

Boeing Distinguished Professor, Health Policy & Administration, Washington State University, Pullman, WA

Mark Anthony Gill, PharmD

Professor, Department of Pharmacy, University of Southern California

Reprints: Dr. Louie, Department of Pharmacy, University of Southern California, 1985 Zonal Ave., Los Angeles, CA 90089-9121, fax 323/442-1395, slouie{at}usc.edu

OBJECTIVE: To review the epidemiology, pathogenesis, and management of patients with -antitrypsin (AAT) deficiency syndrome and compare Aralast with Prolastin, 2 of the 3 available human plasma-derived AAT agents.

DATA SOURCES: Articles were identified using a MEDLINE (1966-September 2005) search with MESH headings that included -antitrypsin and emphysema.

STUDY SELECTION AND DATA EXTRACTION: All papers from peer-reviewed journals on the laboratory or clinical efficacy of plasma-derived AAT (eg, Prolastin, Aralast) for patients with this autosomal recessive disorder were reviewed.

DATA SYNTHESIS: Clinical trials found that AAT augmentation prevents progression of AAT-deficient emphysema and thus its associated morbidity and mortality. Treatment with Aralast has been shown to be safe and well tolerated, with a low incidence of mild to moderate adverse events. Pharmacoeconomics studies of AAT augmentation demonstrated that the use of Aralast was cost-effective as lifelong augmentation therapy for AAT-deficient emphysema.

CONCLUSIONS: Because of its effectiveness and extra safety measure compared with Prolastin, Aralast should be recommended for formulary inclusion.

Key Words: -antitrypsin: Aralast, Prolastin; emphysema

Published Online, October 11, 2005. www.theannals.com, DOI 10.1345/aph.1E061

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-05-033-H01

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