Long-term effect of azithromycin in bronchiolitis obliterans syndrome

IntroductionAzithromycin stabilises and improves lung function forced expiratory volume in one second (FEV1) in lung transplantation patients with bronchiolitis obliterans syndrome (BOS). A post hoc analysis was performed to assess the long-term effect of azithromycin on FEV1, BOS progression and su...

Full description

Saved in:

Bibliographic Details
Published in:	BMJ open respiratory research 2019, Vol.6 (1), p.e000465-e000465
Main Authors:	Gan, C.Tji-Joong, Ward, Chris, Meachery, Gerard, Lordan, James Laurence, Fisher, Andrew J, Corris, Paul A
Format:	Article
Language:	eng
Subjects:	Adult Azithromycin - pharmacology Azithromycin - therapeutic use Bronchiolitis Obliterans - drug therapy Bronchiolitis Obliterans - mortality Bronchiolitis Obliterans - physiopathology Cell cycle Consent Cystic fibrosis Disease Progression Double-Blind Method Female Forced Expiratory Volume - drug effects Heart Humans Lung Transplantation Male Middle Aged Outpatient care facilities Patients Survival Rate Syndrome Time Factors Transplants & implants Treatment Outcome
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	IntroductionAzithromycin stabilises and improves lung function forced expiratory volume in one second (FEV1) in lung transplantation patients with bronchiolitis obliterans syndrome (BOS). A post hoc analysis was performed to assess the long-term effect of azithromycin on FEV1, BOS progression and survival .MethodsEligible patients recruited for the initial randomised placebo-controlled trial received open-label azithromycin after 3 months and were followed up until 6 years after inclusion (n=45) to assess FEV1, BOS free progression and overall survival.ResultsFEV1 in the placebo group improved after open-label azithromycin and was comparable with the treatment group by 6 months. FEV1 decreased after 1 and 5 years and was not different between groups. Patients (n=18) with rapid progression of BOS underwent total lymphoid irradiation (TLI). Progression-free survival (log-rank test p=0.40) and overall survival (log-rank test p=0.28) were comparable. Survival of patients with early BOS was similar to late-onset BOS (log-rank test p=0.74).DiscussionLong-term treatment with azithromycin slows down the progression of BOS, although the effect of TLI may affect the observed attenuation of FEV1 decline. BOS progression and long-term survival were not affected by randomisation to the placebo group, given the early cross-over to azithromycin and possibly due to TLI in case of further progression. Performing randomised placebo-controlled trials in lung transplantation patients with BOS with a blinded trial duration is feasible, effective and safe.
ISSN:	2052-4439 2052-4439