IMPORTANCE Young mouse plasma restores memory in aged mice, but, to our knowledge, the effects are unknown in patients with Alzheimer disease (AD). OBJECTIVE To assess the safety, tolerability, and feasibility of infusions of young fresh frozen plasma (yFFP) from donors age 18 to 30 years in patients with AD. DESIGN, SETTING, AND PARTICIPANTS The Plasma for Alzheimer Symptom Amelioration (PLASMA) study randomized 9 patients under a double-blind crossover protocol to receive 4 once-weekly infusions of either 1 unit (approximately 250 mL) of yFFP from male donors or 250 mL of saline, followed by a 6-week washout and crossover to 4 once-weekly infusions of an alternate treatment. Patients and informants were masked to treatment and subjective measurements. After an open-label amendment, 9 patients received 4 weekly yFFP infusions only and their subjective measurements were unmasked. Patients were enrolled solely at Stanford University, a tertiary academic medical center, from September 2014 to December 2016, when enrollment reached its target. Eighteen consecutive patients with probable mild to moderate AD 1 dementia, a Mini-Mental State Examination (score of 12 to 24 inclusive), and an age of 50 to 90 years were enrolled. Thirty-one patients were screened and 13 were excluded: 11 failed the inclusion criteria and 2 declined to participate. INTERVENTIONS One unit of yFFP from male donors/placebo infused once weekly for 4 weeks. MAIN OUTCOME AND MEASURES The primary outcomes were the safety, tolerability, and feasibility of 4 weekly yFFP infusions. Safety end point analyses included all patients who received the study drug/placebo. RESULTS There was no difference in the age (mean [SD], 74.17 [7.96] years), sex (12 women [67%]), or baseline Mini-Mental State Examination score (mean [SD], 19.39 [3.24]) between the crossover (n = 9) and open-label groups (n = 9). There were no related serious adverse events. One patient discontinued participation because of urticaria and another because of an unrelated stroke. There was no statistically significant difference between the plasma (17 [94.4%]) and placebo (9 [100.0%]) cohorts for other adverse events, which were mild to moderate in severity. The most common adverse events in the plasma group included hypertension (3 [16.7%]), dizziness (2 [11.1%]), sinus bradycardia (3 [16.7%]), headache (3 [16.7%]), and sinus tachycardia (3 [16.7%]). The mean visit adherence (n = 18) was 86% (interquartile range, 87%-100%) and adherence, accounting for a reduction in the total visit requirement due to early patient discontinuation, was 96% (interquartile range, 89%-100%). CONCLUSIONS AND RELEVANCE The yFFP treatment was safe, well tolerated, and feasible. The study's limitations were the small sample size, short duration, and change in study design. The results warrant further exploration in larger, double-blinded placebo-controlled clinical trials.
Summary This study tested the effectiveness of flunisolide in the treatment of children with seasonal allergic rhinitis. Thirty‐five children between the ages of 5 and 14 years used an intransal preparation of either flunisolide (200 μg/day) or placebo for a 6‐week double‐blind parallel trial consisting of a 2‐week baseline phase and a 4‐week treatment phase, conducted during a period of ‘high’ pollen counts in Adelaide, South Australia. Flunisolide was effective in reducing four symptoms of hay fever: sneezing, stuffy nose, runny nose and eye itch. Sixty‐four percent of the flunisolide‐treated group and 33% of the placebo‐treated group noted substantial or total control of their hay fever symptoms (P <0.05). The effect of the intranasal administration of flunisolide on the pituitary‐adrenal axis was monitored by performing plasma cortisol measurements (a.m. and p.m.) and 24‐hr urinary free cortisol excretion studies for each patient. The data confirmed that 200 μg/day intranasal flunisolide does not suppress the pituitary‐adrenal‐axis in this young patient population.
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