Steady-State Therapy with Azithromycin or Low-Dose Prednisolone in Paediatric Cystic Fibrosis Patients: Inflammatory
Galina Shmarina1, Alexander Pukhalsky, Lucine Avakian
1Research Centre for Medical Genetics, Russian Paediatric Clinical Hospital, Moscow, Russia.
Insights
Anti-inflammatory treatments like azithromycin and prednisolone may modulate inflammation in cystic fibrosis (CF) patients. Azithromycin showed benefits for CF-related liver disease but increased glucose issues.
Area of Science:
- Pediatric Pulmonology
- Immunology
- Pharmacology
Background:
- Cystic Fibrosis (CF) is characterized by progressive lung function decline.
- Anti-inflammatory therapy is a potential strategy to slow CF progression.
- Evaluating inflammatory markers and disease progression in CF patients receiving azithromycin or low-dose prednisolone.
Purpose of the Study:
- To assess the impact of chronic azithromycin or low-dose prednisolone treatment on inflammatory markers.
- To evaluate disease progression in pediatric CF patients under these anti-inflammatory regimens.
- To compare these markers and progression against CF patients without anti-inflammatory treatment.
Main Methods:
- Cross-sectional analysis of plasma and sputum biomarkers.
- Inclusion of 204 CF patients and 100 healthy controls.
- CF patients categorized into: basic therapy only (WAT), azithromycin, or low-dose prednisolone groups.
Main Results:
- WAT group showed elevated IFN-γ, IL-10, TGFβ1 and decreased TNFα, ACTH compared to controls.
- Azithromycin/prednisolone groups had higher plasma TNFα and lower IL-10 than WAT.
- Azithromycin group showed normal ACTH, reduced CF-liver disease, and increased glucose metabolism disturbances.
Conclusions:
- Chronic anti-inflammatory treatments may offer sustained immunomodulatory effects in CF.
- Further research is needed on azithromycin's impact on the HPA axis and non-pulmonary complications.
- Low-dose prednisolone and azithromycin warrant further investigation for CF management.
Background:
Anti-inflammatory therapy is a logical approach to slowing the inevitable lung function deterioration in cystic fibrosis (CF) patients. This study's aim was to evaluate inflammatory markers and disease progression in paediatric CF patients chronically treated with azithromycin or low-dose prednisolone.
Methods:
The study included 204 patients with CF and 100 healthy controls; 102 CF patients were treated with basic therapy only (without anti-inflammatory treatment; WAT), and 102 individuals received basic therapy along with azithromycin (n = 59) or low-dose prednisolone (n = 43). The median duration of therapy was 24 months (range 12-82) with azithromycin and 31 months (range 12-180) with prednisolone. A cross-sectional analysis of plasma and sputum biomarkers was performed.
Results:
Compared with the healthy controls, the WAT group showed elevated IFN-γ, IL-10 (total), and TGFβ1 concentrations, and decreased TNFα (total) and adrenocorticotropic hormone (ACTH) levels (all p < 0.05). Plasma TNFα (total) concentrations in azithromycin/prednisolone patients were significantly higher than those in WAT patients and similar to those of healthy children. In contrast, IL-10 (total) levels were significantly decreased in azithromycin/prednisolone-treated patients compared with WAT patients. Children from the azithromycin group demonstrated ACTH levels similar to those of healthy controls. Azithromycin-treated patients showed a significantly reduced rate of CF-related liver disease and a significantly increased incidence of glucose metabolism disturbances.
Conclusions:
Steady-state anti-inflammatory treatments may have a sustained immunomodulatory action at systemic and local levels in CF patients. Further investigations are needed to assess the effects of supportive azithromycin therapy on the hypothalamic-pituitary-adrenal axis and the incidence of non-pulmonary CF complications.
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