The effect of maintenance azithromycin on radiological features in patients with bronchiectasis - Analysis from the BAT randomized controlled trial.

Abstract

RATIONALE:

Bronchiectasis (abnormal dilatation of bronchi) is usually diagnosed by high resolution computed tomography (HRCT) and radiological severity has been found to correspond with clinical outcome. A beneficial effect of macrolides maintenance treatment in frequent exacerbating bronchiectasis patients has been established in randomized trials. This study was undertaken to prospectively evaluate the effect of long-term azithromycin (AZM) on radiological features in patients with bronchiectasis.

METHODS:

The BAT randomized controlled trial (2008-2010) investigated the effect of 1 year of AZM (250 mg OD) in bronchiectasis with frequent exacerbations. Chest (HR)CT-scans at baseline and after one year of study treatment were obtained and scored by two radiologists according to the Brody - and the Bhalla scoring system.

RESULTS:

77 (93%) patients conducted the BAT trial were evaluated in this post-hoc analysis. A significant improvement of the radiological features based on the Brody score was found after one year of AZM therapy as compared to placebo (p = 0.024), with a not significant improvement of the Bhalla score (p=0.071). Especially the consolidation (Bhalla) and parenchymal changes (Brody) sub scores significantly improved (both p=0.030), and even a radiological deterioration was seen on the Brody bronchiectasis sub score for the placebo treated patients (mean 14.5 (11.7) vs.15.7 (11.9)).

CONCLUSIONS:

The beneficial effect of long-term AZM treatment on radiological features was demonstrated in this randomized controlled trial. (HR)CT's can be used as an objective measure of treatment response in bronchiectasis.

CLINICAL TRIAL REGISTRATION NUMBER:

NCT00415350.

• Authors: Lotte C Terpstra, Josje Altenburg, Firdaus A Mohamed Hoesein, Inez Bronsveld, Shirley Go, Philip A C van Rijn, Pim A De Jong, Harry G M Heijerman, Wim G Boersma
• Journal: Respiratory medicine (Respir Med) Vol. 192 Pg. 106718 (02 2022) ISSN: 1532-3064 [Electronic] England
• PMID: 34974413 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Macrolides
• Azithromycin

Topics

• Anti-Bacterial Agents (therapeutic use)
• Azithromycin (pharmacology, therapeutic use)
• Bronchiectasis (diagnostic imaging, drug therapy)
• Humans
• Macrolides (therapeutic use)
• Tomography, X-Ray Computed (methods)