Neomacrolides in the treatment of patients with severe asthma and/or bronchiectasis: a retrospective observational study

Coeman, Mathieu; Durme, Yannick Van; Bauters, F; Deschepper, Ellen; Demedts, Ingel K.; Smeets, Peter; Joos, Guy; Brusselle, Guy

doi:10.1177/1753465811406771

Cited by 20 publications

(21 citation statements)

References 57 publications

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“…The immunomodulatory effects of macrolides are thought to result in reduction in sputum volume, inhibition of virulence factor production by bacteria, diminished neutrophil influx and downregulation of IL-8 production, inhibition of NF- κβ production, and reduction in both ICAM-1 and neutrophil elastase [51–54]. These immunomodulatory effects result in a reduction in pulmonary exacerbations, improved lung function, and improved quality of life [28, 55–61]. The clinical improvement of subjects may take up to three months to show an effect.…”

Section: Macrolides and Bronchiectasismentioning

confidence: 99%

The Role of Macrolides in Childhood Non-Cystic Fibrosis-Related Bronchiectasis

Masekela

Green

2012

Mediators of Inflammation

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Non-cystic fibrosis-related bronchiectasis is a chronic inflammatory lung disease, which is regarded as an “orphan” lung disease, with little research devoted to the study of this condition. Bronchiectasis results in impaired quality of life and mortality if left untreated. The tools available in the armamentarium for the management of bronchiectasis entail antibiotic therapy traditionally used to treat exacerbations, stratagems to improve mucociliary clearance, and avoidance of toxins. Macrolides have been known for the last two decades to have not only anti-bacterial effects but immunomodulatory properties as well. In cystic fibrosis, the use of macrolides is well documented in subjects colonized withPseudomonas aeruginosa, to improve quality of life and lung function. There is currently emerging evidence to suggest the benefit of macrolides in subjects not colonized withPseudomonas aeruginosa. This beneficial effect has been less explored in the context of bronchiectasis from other causes. The purpose of this paper is to review the current literature on the use of macrolides in non-cystic fibrosis related bronchiectasis in paediatrics.

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Section: Macrolides and Bronchiectasismentioning

confidence: 99%

The Role of Macrolides in Childhood Non-Cystic Fibrosis-Related Bronchiectasis

Masekela

Green

2012

Mediators of Inflammation

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“…Maintenance treatment with macrolides such as azithromycin has been proved to be effective in chronic neutrophilic airway diseases including cystic fibrosis, bronchiectasis and diffuse panbronchiolitis 9–12. In an observational study, we have demonstrated the benefits of short-term macrolide treatment in patients with severe asthma 13. Recently, erythromycin and azithromycin—added to usual therapy—have been shown to prevent exacerbations in patients with chronic obstructive pulmonary disease (COPD), a predominantly neutrophilic airway disease 14–16…”

Section: Introductionmentioning

confidence: 99%

Azithromycin for prevention of exacerbations in severe asthma (AZISAST): a multicentre randomised double-blind placebo-controlled trial

Brusselle

VanderStichele

Jordens

et al. 2013

Thorax

Self Cite

429

334

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Background Patients with severe asthma are at increased risk of exacerbations and lower respiratory tract infections (LRTI). Severe asthma is heterogeneous, encompassing eosinophilic and non-eosinophilic (mainly neutrophilic) phenotypes. Patients with neutropilic airway diseases may benefit from macrolides. Methods We performed a randomised double-blind placebo-controlled trial in subjects with exacerbationprone severe asthma. Subjects received low-dose azithromycin (n=55) or placebo (n=54) as add-on treatment to combination therapy of inhaled corticosteroids and long-acting β 2 agonists for 6 months. The primary outcome was the rate of severe exacerbations and LRTI requiring treatment with antibiotics during the 26-week treatment phase. Secondary efficacy outcomes included lung function and scores on the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ). Results The rate of primary endpoints (PEPs) during 6 months was not significantly different between the two treatment groups: 0.75 PEPs (95% CI 0.55 to 1.01) per subject in the azithromycin group versus 0.81 PEPs (95% CI 0.61 to 1.09) in the placebo group (p=0.682). In a predefined subgroup analysis according to the inflammatory phenotype, azithromycin was associated with a significantly lower PEP rate than placebo in subjects with noneosinophilic severe asthma (blood eosinophilia ≤200/ml): 0.44 PEPs (95% CI 0.25 to 0.78) versus 1.03 PEPs (95% CI 0.72 to 1.48) (p=0.013). Azithromycin significantly improved the AQLQ score but there were no significant between-group differences in the ACQ score or lung function. Azithromycin was well tolerated, but was associated with increased oropharyngeal carriage of macrolide-resistant streptococci. Conclusions Azithromycin did not reduce the rate of severe exacerbations and LRTI in patients with severe asthma. However, the significant reduction in the PEP rate in azithromycin-treated patients with non-eosinophilic severe asthma warrants further study. ClinicalTrials.gov number NCT00760838.

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“…In one trial, responders were older and had a longer duration of asthma [60]. Other studies have suggested that PCR identification of Mycoplasma and Chlamydophila pneumoniae or neutrophilic inflammation best identifies the macrolide responsive phenotype [61,62].…”

Section: Microbiome-driven Th2-low Asthma Phenotypementioning

confidence: 98%

Endotype Driven Treatment of Asthma

Agache

2014

Curr Treat Options Allergy

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Neomacrolides in the treatment of patients with severe asthma and/or bronchiectasis: a retrospective observational study

Cited by 20 publications

References 57 publications

The Role of Macrolides in Childhood Non-Cystic Fibrosis-Related Bronchiectasis

The Role of Macrolides in Childhood Non-Cystic Fibrosis-Related Bronchiectasis

Azithromycin for prevention of exacerbations in severe asthma (AZISAST): a multicentre randomised double-blind placebo-controlled trial

Endotype Driven Treatment of Asthma

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