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Maintenance azithromycin therapy for bronchiolitis obliterans syndrome: results of a pilot study
Susan G Gerhardt1, John F McDyer, Reda E Girgis
1Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Abstract:
Bronchiolitis obliterans syndrome remains the leading cause of morbidity and mortality in the pulmonary transplant population. Previous studies show that macrolide antibiotics may be efficacious in the treatment of panbronchiolitis and cystic fibrosis. In the latter, azithromycin decreases the number of respiratory exacerbations, improves FEV1, and improves quality of life. We hypothesized that oral azithromycin therapy may improve lung function in patients with bronchiolitis obliterans syndrome. To test this hypothesis, we conducted an open-label pilot trial using maintenance azithromycin therapy in six lung transplant recipients (250 mg orally three times per week for a mean of 13.7 weeks). In this study, five of these six individuals demonstrated significant improvement in pulmonary function, as assessed by FEV1, as compared with their baseline values at the start of azithromycin therapy. The mean increase in the percentage of predicted FEV1 values in these individuals was 17.1% (p
Insights
Azithromycin therapy may improve lung function in lung transplant recipients with bronchiolitis obliterans syndrome. This pilot study showed significant improvements in FEV1, suggesting macrolides could be a potential treatment.
Area of Science:
- Pulmonary Medicine
- Transplantation Immunology
- Pharmacology
Background:
- Bronchiolitis obliterans syndrome (BOS) is a primary cause of death in lung transplant recipients.
- Macrolide antibiotics, like azithromycin, have shown efficacy in treating panbronchiolitis and cystic fibrosis.
- Azithromycin use in cystic fibrosis is linked to reduced exacerbations, improved FEV1, and enhanced quality of life.
Purpose of the Study:
- To investigate the potential of oral azithromycin therapy to improve lung function in patients diagnosed with BOS.
- To test the hypothesis that azithromycin can positively impact pulmonary function in lung transplant recipients experiencing BOS.
Main Methods:
- An open-label pilot trial was conducted involving six lung transplant recipients.
- Participants received maintenance azithromycin therapy at a dose of 250 mg orally, three times per week.
- Treatment duration averaged 13.7 weeks, with pulmonary function (FEV1) assessed against baseline values.
Main Results:
- Five out of six participants demonstrated a significant improvement in forced expiratory volume in one second (FEV1).
- The mean increase in the percentage of predicted FEV1 values was 17.1% (p ≤ 0.05).
- Absolute FEV1 showed a mean increase of 0.50 L, with a range from -0.18 L to 1.36 L.
Conclusions:
- The findings suggest that maintenance azithromycin therapy may offer a beneficial role in managing BOS.
- This macrolide therapy shows potential for improving lung function in lung transplant recipients suffering from BOS.
- Further research is warranted to confirm these preliminary results and establish azithromycin's efficacy in BOS treatment.