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

• Published in: Respiratory medicine Vol. 192; p. 106718
• Main Authors: Terpstra, Lotte C., Altenburg, Josje, Mohamed Hoesein, Firdaus A., Bronsveld, Inez, Go, Shirley, van Rijn, Philip A.C., De Jong, Pim A., Heijerman, Harry G.M., Boersma, Wim G.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2022
• Subjects: Anti-Bacterial Agents - therapeutic use; Azithromycin (AZM); Azithromycin - pharmacology; Azithromycin - therapeutic use; Bronchiectasis; Bronchiectasis - diagnostic imaging; Bronchiectasis - drug therapy; High resolution computed tomography (HRCT); Humans; Immunomodulation; Macrolides - therapeutic use; Radiology; Tomography, X-Ray Computed - methods; Radiology; Bronchiectasis; Azithromycin (AZM); High resolution computed tomography (HRCT); Immunomodulation
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2021.106718

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. 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. 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)). 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. NCT00415350