The impact of dornase alfa on imaging features of bronchiectasis.

Background: Nebulized dornase alfa is an approved therapy for persons with cystic fibrosis, but not for other causes of bronchiectasis. Nonetheless, dornase works by breaking down extracellular DNA in airway phlegm and should be effective in people with bronchiectasis who have excessive purulent phlegm. The purpose of this study was to look at radiographic changes in persons with bronchiectasis (not CF) treated with dornase alfa. Methods: This is a single-center retrospective review of clinical data and analysis of images after initial treatment with dornase alfa. Eligible subjects included those with documented bronchiectasis who were treated with dornase alfa as part of their clinical care and who had chest computed tomography performed prior to and shortly after initial treatment. Descriptive clinical data are provided but not analyzed. Images were analyzed using validated methods including an artificial-intelligence-based algorithm to assess measures of bronchiectasis, airway wall thickness, and mucus plugs comparing before and after treatment. Results: Eleven subjects were treated with dornase alfa without complication and with improved symptoms and reduced numbers of pulmonary exacerbations. One subject had improvement in pulmonary function. There was a nominal reduction in a measure of bronchiectasis and the number and volume of mucus plugs after dornase alfa compared to pre-treatment. Conclusions: This novel image analysis of the impact of dornase alfa on features of bronchiectasis is consistent with the improved clinical symptoms reported by the subjects. These observations may help define better criteria to predict which bronchiectasis subjects are most likely to benefit from dornase alfa therapy.