Key result
Long-term clarithromycin is linked to slowing FEV1 decline by ~155 mL/month in lung transplant recipients.
Why the study?
Does long-term clarithromycin improve lung function in lung transplant recipients with Bronchiolitis Obliterans Syndrome?
Cohort (n=31)
Does long-term clarithromycin improve lung function in lung transplant recipients with Bronchiolitis Obliterans Syndrome?
Long-term clarithromycin effectively improves lung function in more than one-third of lung transplant recipients with BOS or potential BOS, comparable to results reported with azithromycin.
May support clarithromycin in BOS; extends macrolide observations but leaves open need for RCTs to confirm benefit.
BACKGROUND: The successful use of azithromycin in lung transplant recipients with Bronchiolitis Obliterans Syndrome (BOS) has been described, its mechanisms of action, however, are not known. We report the largest experience of long-term clarithromycin (CLAR) in lung transplant patients with BOS or potential BOS. METHODS: Transplant recipients receiving CLAR for BOS or potential BOS were included (2000-2008). Response to CLAR was defined as an FEV1 increase of >10% at 6 months compared to the FEV1 recorded at initiation of CLAR. RESULTS: 31 patients were included. 12 recipients (39%) responded to CLAR after 6 months, 10/12 recipients responded already after 3 months. Responders showed a mean FEV1 increase of 732 mL (95% CI: 537-938 mL) by 6 months (p<0.001). Overall, patients experienced a FEV1 decline of 181 mL/month prior to CLAR, and a 25 mL/month decline over the 6-months after initiation of CLAR; p=0.015, mean (95% CI) change in rate of decline 155 (32-279). DISCUSSION: We show that long-term CLAR effectively improves lung function in more than one-third of recipients with BOS or potential BOS, comparable to results reported with long-term azithromycin.
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Benden et al. (2009) conducted a cohort in Bronchiolitis Obliterans Syndrome (BOS) or potential BOS in lung transplant recipients (n=31). Clarithromycin vs. Prior to clarithromycin initiation (pre-treatment baseline) was evaluated on Response to clarithromycin (defined as an FEV1 increase of >10% at 6 months compared to initiation). Long-term clarithromycin in lung transplant recipients with BOS yielded a 39% response rate at 6 months and reduced the FEV1 decline rate by 155 mL/month (95% CI 32-279; p=0.015).
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