Synthetic surfactants: where are we? Evidence from randomized, controlled clinical trials.
The benefits of exogenous synthetic or animal-derived surfactants for prevention or treatment of respiratory distress syndrome (RDS) are well established. Data from head-to-head trials comparing animal-derived surfactants primarily with the synthetic surfactant colfosceril suggest that the major clinical advantages afforded by the presence of surfactant protein (SP)-B and SP-C in animal-derived preparations relate to faster onset of action, a reduction in the incidence of RDS when used prophylactically, and a lower incidence of air leaks and RDS-related deaths. However, no benefits in terms of overall mortality or BPD have been shown in these head-to-head comparisons. Findings from trials of a new-generation synthetic surfactant containing a peptide that mimics SP-B, as well as their follow-up study suggest that its administration improves short-term clinical outcomes compared with colfosceril and results in survival through 1 year of age, which is at least comparable, if not perhaps superior, to that seen with animal-derived surfactants.
Moya
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Department of Neonatology, New Hanover Regional Medical Center, Wilmington, NC 28402-9025, USA. Fernando.moya@seahec.net
D000818:Animals; D001688:Biological Products / Q000008:administration & dosage / Q000009:adverse effects / Q000138:chemical synthesis; D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D019317:Evidence-Based Medicine; D005233:Fatty Alcohols / Q000008:administration & dosage / Q000009:adverse effects / Q000138:chemical synthesis; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D010715:Phosphatidylglycerols / Q000008:administration & dosage / Q000009:adverse effects / Q000138:chemical synthesis; D010743:Phospholipids / Q000008:administration & dosage / Q000009:adverse effects / Q000138:chemical synthesis; D010767:Phosphorylcholine / Q000008:administration & dosage / Q000009:adverse effects / Q000138:chemical synthesis; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects / Q000138:chemical synthesis; D011506:Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000138:chemical synthesis; D037661:Pulmonary Surfactant-Associated Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis; D011663:Pulmonary Surfactants / Q000008:administration & dosage / Q000009:adverse effects / Q000138:chemical synthesis*; D016032:Randomized Controlled Trials as Topic; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
D001688:Biological Products; D004338:Drug Combinations; D005233:Fatty Alcohols; D010715:Phosphatidylglycerols; D010743:Phospholipids; D011506:Proteins; D037661:Pulmonary Surfactant-Associated Proteins; D011663:Pulmonary Surfactants; C502722:lucinactant; D010767:Phosphorylcholine; D011092:Polyethylene Glycols; C047049:dipalmitoylphosphatidylcholine, hexadecanol, tyloxapol drug combination; C068291:poractant alfa; C117342:calfactant; C072197:beractant