Abstract | BACKGROUND: METHODS: 239 Lung transplant recipients were retrospectively studied. ΔFEV1 ± 10% from FEV1 at azithromycin initiation for ≥7 consecutive days in HS or ≥2 measures in OS were taken as cut-off for response or progression. RESULTS: Based upon HS, 161/239 (67%) patients were progressive despite macrolide, 19 of who exhibited transient improvement in FEV1 (11%). Time to progression was 29 (13-96) days earlier with HS than in OS. Forty-six (19%) recipients responded in HS after median 81 (22-343) days, whilst 22% remained stable. Concordance in azithromycin treatment response between OS and HS was observed in 210 of 239 patients (88%). Response or stabilization conferred significant improvement in survival (p = 0.005). Transient azithromycin responders demonstrated improved survival when compared to azithromycin refractory patients (p = 0.034). CONCLUSIONS: HS identified azithromycin refractory patients significantly earlier than OS, possibly facilitating aggressive treatment escalation that may improve long-term outcome. Treatment response to azithromycin should be assessed 4 weeks after initiation. Responders demonstrated best survival, with even transient response conferring benefit. Macrolide-refractory BOS carried the worst prognosis.
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Authors | Claudia de Wall, Dettmer Sabine, Warnecke Gregor, Greer Mark, Haverich Axel, Fuehner Thomas, Welte Tobias, Gottlieb Jens |
Journal | Respiratory medicine
(Respir Med)
Vol. 108
Issue 2
Pg. 405-12
(Feb 2014)
ISSN: 1532-3064 [Electronic] England |
PMID | 24445061
(Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2014 Elsevier Ltd. All rights reserved. |
Chemical References |
- Anti-Bacterial Agents
- Azithromycin
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Topics |
- Adult
- Anti-Bacterial Agents
(therapeutic use)
- Azithromycin
(therapeutic use)
- Bronchiolitis Obliterans
(drug therapy, mortality, physiopathology)
- Disease Progression
- Drug Resistance, Bacterial
- Early Diagnosis
- Female
- Forced Expiratory Volume
(drug effects)
- Home Care Services
- Humans
- Lung Transplantation
- Male
- Middle Aged
- Retrospective Studies
- Spirometry
(methods)
- Survival Analysis
- Treatment Outcome
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