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Title
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Long-term azithromycin therapy for bronchiolitis obliterans syndrome : divide and conquer?
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Author
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Abstract
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| BACKGROUND Azithromycin may reverse or halt the decline of pulmonary function (FEV(1)) in bronchiolitis obliterans syndrome (BOS) In this study we investigated the effects of long-term azithromycin treatment in lung transplant recipients with BOS METHODS A retrospective, observational cohort study was performed on 107 patients with BOS (Stages 0p/1/2/3, n = 23/62/20/2), who were treated with azithromycin for 3 1 +/- 1 9 years Patients were evaluated 6 3 +/- 3 8 years after transplantation and assessed for evolution of FEV(1), bronchoalveolar lavage neutrophilia and overall survival after initiation of azithromycin Survival curves were analyzed using the log rank test Cox proportional hazard survival regression analysis was performed to estimate hazard ratios of clinical variables predicting outcome RESULTS FEV(1), Increased >= 10% after 3 to 6 months of treatment in 40% of patients, of whom 33% later redeveloped BOS FEV(1) further declined in 78% and stabilized in 22% of the remaining non-responders Pre-treatment neutrophilia was higher in responders 293% (93% to 697%) vs 11 5% (29% to 438%) (p = 0 025) in whom it significantly decreased to 42% (1 8% to 17 6%) (p = 0 041) after 3 to 6 months of azithromycin Responders demonstrated better survival compared with non-responders (p = 0050), with 6 and 21 patients, respectively, dying during follow-up (p = 0 027) Multivariate analysis identified initial azithromycin response and earlier post transplant initiation of azithromycin to be protective for both BOS progression/relapse (hazard ratio [HR] = 0 12 [95% confidence interval 005 to 028], p < 0 0001 and HR = 098 [95% confidence interval 097 to 098], p < 0 0001, respectively) and retransplantation/death during follow-up (HR 0 10 [95% confidence interval 0 02 to 0 48] p = 0004, and BR 0 96 [95% confidence interval 095 to 098] p < 0 0001, respectively) CONCLUSIONS Long term azithromycin benefits pulmonary function and survival in BOS particularly in patients with Increased lavage neutrophilia J Heart Lung Transplant 2010 29 1358-68 (C) 2010 International Society for Heart and Lung Transplantation All rights reserved |
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Language
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English
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Source (journal)
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Journal of heart and lung transplantation. - St-Louis, Mo.
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Publication
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St-Louis, Mo.
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2010
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ISSN
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1053-2498
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DOI
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10.1016/J.HEALUN.2010.05.023
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Volume/pages
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29
:12
(2010)
, p. 1358-1368
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ISI
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000285220700006
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Pubmed ID
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20619683
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Full text (Publisher's DOI)
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