Impact of azithromycin on serum inflammatory markers in children with cystic fibrosis and new Pseudomonas |
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| Affiliation: | 1. Department of Pediatrics, Washington University, St. Louis, MO, United States;2. Department of Pediatrics, University of Washington, Seattle, WA, United States;3. Seattle Children''s Hospital, Seattle, WA, United States;4. Department of Biostatistics, University of Washington, Seattle, WA, United States;5. Department of Pediatrics, Children''s Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, United States;6. Department of Pediatrics, University of North Carolina, Chapel Hill, NC, United States;1. Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada;2. Department of Paediatrics, University of Toronto, Canada;3. Translational Medicine Program, SickKids Research Institute, Toronto, Canada;1. Imaging Department, Hopital Nord, APHM, Aix Marseille University;2. Aix Marseille Univ, LIIE, Marseille, France;3. Aix Marseille Univ, CERIMED, Marseille, France;4. Service de Pneumologie et équipe de transplantation pulmonaire, Centre de Ressources et de Compétences de la Mucoviscidose (CRCM) Adulte, AP-HM Hôpital Nord,13015, Marseille France;5. Aix Marseille Université, Service de radiologie, La Timone Hôpital, 264 rue Saint Pierre, 13005 Marseille;6. Service d''anatomie et cytologie pathologiques, Hôpital Nord, chemin des Bourrely, 13015 Marseille, France;7. U1068- CRCM, Aix Marseille université, 13015 Marseille, France;8. Service de chirurgie thoracique et Transplantation Pulmonaire, hôpital Nord, chemin des Bourrely, 13015 Marseille, France;9. Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, ISSPAM, Hop Timone, Biostatistics department, BIOSTIC, Marseille, F-13005, France;1. Adult CF Unit, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK;2. Department of Radiology, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK;3. Institute of Infection and Global Health, University of Liverpool, Liverpool, UK;4. Research Unit, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK;5. Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK;6. Institute in the Park (University of Liverpool), Alder Hey Children''s Hospital, Liverpool, UK;7. Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK;1. NIHR Academic Clinical Fellow, Leeds teaching Hospitals NHS Foundation Trust, United Kingdom;2. Cystic Fibrosis/Respiratory Medicine Consultant, Bristol Adult Cystic Fibrosis Centre, United Kingdom;1. Department of Pediatrics, UNC School of Medicine, University of North Carolina, 450 MacNider Building, CB# 7217 321 S. Columbia Street, Chapel Hill, NC, United States;2. Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States;3. Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States;4. Department of Infection Prevention & Control, New York-Presbyterian Hospital, New York, NY, United States |
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| Abstract: | Chronic azithromycin improves outcomes in cystic fibrosis (CF), but its mechanism of action is unclear. The OPTIMIZE trial demonstrated improvement in time to first pulmonary exacerbation in children with new Pseudomonas treated with azithromycin. Azithromycin effect on systemic markers of inflammation over 18 months was assessed by change from baseline for high-sensitivity C-reactive protein, myeloperoxidase, calprotectin and absolute neutrophil count in the OPTIMIZE population. Subjects treated with chronic azithromycin or placebo had samples collected at baseline, 39 and 78 weeks of treatment. In 129 subjects, a significant decrease in high-sensitivity C-reactive protein was present at 39 weeks in the azithromycin group compared to placebo, but no significant difference between the groups at 78 weeks. No differences in change from baseline in myeloperoxidase, calprotectin or absolute neutrophil count were present at either time point. This supports the concept of a transient immunomodulatory effect for chronic azithromycin therapy in children with CF. |
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