Long-term effect of azithromycin in bronchiolitis obliterans syndrome

Gan, C. T-J., Ward, C., Meachery, G., Lordan, J. L., Fisher, A. J. & Corris, P. A., 15-Oct-2019, In : BMJ open respiratory research. 6, 1, 5 p., 000465.

Research output: Contribution to journalArticleAcademicpeer-review

  • C. Tji-Joong Gan
  • Chris Ward
  • Gerard Meachery
  • James Laurence Lordan
  • Andrew J. Fisher
  • Paul A. Corris

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.

Original languageEnglish
Article number000465
Number of pages5
JournalBMJ open respiratory research
Issue number1
Publication statusE-pub ahead of print - 15-Oct-2019



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