I have waited a long time to see even one dronedarone (Multaq) success story. In the interest of having a fair and balanced blog, I report my first witnessed favorable therapeutic response to the controversial new Sanofi AF drug, dronedarone.
Four months ago, I saw him in consultation for an inappropriate ICD shock due to rapidly conducting AF. He is young, has only moderate LV dysfunction, a prior stent, and this was his third recent episode of AF. I started dronedarone in hopes that it would suppress his AF, and even if it didn’t suppress all episodes, at least it would have rate modulating effects.
At four month follow-up, he showed no AF episodes from his ICD evaluation, and he reports feeling well without symptoms or drug side effects.
Like the pitcher with the no-hitter going in the fifth inning (in dronedarone’s case maybe the third inning), it is still way too early to celebrate. Also, one of my partners is still batting zero in his dronedarone experience. But at least now, I have seen one success, albeit with a very short duration of follow-up.
We will see.
Fair is fair.
JMM
AM says
You've used the phrase "rapidly conducting AF" in multiple posts. I can't find a definition of that phrase on the internet. Isn't all AF rapidly conducting? Could you please explain the term? Thx.
Anonymous says
John, A great review on dronedarone in JACC Nov 15, 2010. It has the same efficacy at preventing a fib as quinidine. Uh-oh s step backwards. It is the mst overhyped drug that I have seen in cardiology in years and as an extremely limited to zero role.
Bill
Anonymous says
OK. Help me understand why so negative on this new drug. Which drug or which procedure is 100% effective and 100% safe. When looking at the drugs that are used to treat AF, all are toxic, yet at best 60-65% effective and that's with aminodrone. So what, the drug's not the second coming, but it's paid for by most insurance companies, this surely is not based off of 4-6 patients studied. Maybe they see the value in the outcomes data in a large peer reviewed study. Hospitalization vs outpatient? I don't know isn't worth a try. I have great respect and I am not envious of the medical staff who are faced with treating patients with this disease. It's tough on doctors-not getting the reimbursement for the time and effort in educating and treating patients, and tough on patients who suffer with repeated symptoms and admissions to the hospital. But, when there are different options and choices of drug therapy available to treat AF, doesn't the patient win in the end.
DrJohnM says
Anony,
I am not hard on Multaq, rather, I am just chronicling my experience.
Sanofi pushed this drug hard to the general cardiology community, and as such, many of my colleagues used it frequently. This initial bolus of enthusiasm provided an adequate cohort to get a feel for Multaq's efficacy. Until this patient came to me with a positive response (albeit only 4 months), I had yet to see any patient achieve any degree of AF suppression. Like zero.
You are right that the efficacy of AF rhythm-controlling drugs are limited, but all of our established generic agents are tried and true. When applied intelligently, they work to the degree expected.
JMM
JMM