Long-term effect of azithromycin in bronchiolitis obliterans syndrome. (15th October 2019)

• Record Type: Journal Article
• Authors: Gan, C.Tji-Joong; Ward, Chris; Meachery, Gerard; Lordan, James Laurence; Fisher, Andrew J; Corris, Paul A
• Is Part Of: BMJ open respiratory research. Volume 6:(2019)Supplement 1
• Publication Date: 2019-10-15
• Subjects: lung transplantation; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Diseases -- Treatment -- Periodicals; Respiratory therapy -- Periodicals; 616.2005
• DOI: 10.1136/bmjresp-2019-000465
• Languages: English
• ISSNs: 2052-4439

Abstract

Abstract : Introduction: Azithromycin 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 . Methods: Eligible 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. Results: FEV1 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). Discussion: Long-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.