Valve regurgitation often improves after dexfenfluramine discontinuation

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Valve regurgitation often improves after dexfenfluramine discontinuation

Last Updated: 2001-02-19 17:00:29 EST (Reuters Health)

WESTPORT, CT (Reuters Health) - Valve regurgitation as a result of

fenfluramine or dexfenfluramine treatment often improves after patients

discontinue therapy, according to results of two recent studies. Other

patients remain stable, while only a few experience worsening valvular

function.

Dr. G. Jollis of Duke University Medical Center in Durham, North

Carolina and colleagues compared echocardiograms obtained from 50 patients

up to 981 days after discontinuing treatment with fenfluramine or

dexfenfluramine. The patients were reassessed approximately 1 year later.

Drug treatment had ranged from 65 to 1432 days, the investigators report in

the ls of Internal Medicine for February 20.

Initially, 38 patients exhibited at least mild mitral regurgitation, with

severe regurgitation in 16 subjects. This improved by at least one grade in

17 patients and worsened in 2 patients. Mitral valve leaflet restriction,

which was present in 30 patients at the first echocardiogram, improved in 11

patients and worsened in 2 patients. Similar results were observed among

patients with aortic regurgitation.

The investigators note that improvement often involved multiple valves on

both sides of the heart. There appeared to be no association between

improvement and duration of drug treatment or time between echocardiograms.

Dr. Jollis and his associates conclude that surgical referral for patients

with severe regurgitation may be delayed. Serial echocardiography,

prophylaxis against endocarditis and medical therapy may be appropriate for

patients who, even in the presence of severe regurgitation, have minimal

symptoms and normal left ventricular function.

In another study in the same issue, Dr. Neil J. Weissman of the Washington

Hospital Center in Washington, DC, and associates followed 914 patients who

had been treated for 2 to 3 months with dexfenfluramine, its

sustained-release formulation, or placebo. Paired echocardiograms videotaped

from 1 to 3 months after treatment discontinuation and again 1 year later

were compared.

The initial echocardiographs showed a prevalence of aortic regurgitation

that was slightly higher in those who took dexfenfluramine. During the

following year, aortic regurgitation increased in 0.7% of those who had

taken either formulation of the drug, and decreased in 6.4% of those who

received dexfenfluramine and in 5.1% of those who received sustained-release

dexfenfluramine. There was no significant decrease in patients who received

placebo.

According to editorialist Dr. St. Sutton from the Hospital of

the University of Pennsylvania in Philadelphia, these findings " may be a

silver lining to the dark cloud of anorexogen-related valvulopathy. "

Ann Intern Med 2001;134:261-273,335-337.

-Westport Newsroom 203 319 2700