Cryptogenic organizing pneumonia-Results of treatment with clarithromycin versus corticosteroids-Observational study

• Published in: PloS one Vol. 12; no. 9; p. e0184739
• Main Authors: Radzikowska, Elżbieta, Wiatr, Elżbieta, Langfort, Renata, Bestry, Iwona, Skoczylas, Agnieszka, Szczepulska-Wójcik, Ewa, Gawryluk, Dariusz, Rudziński, Piotr, Chorostowska-Wynimko, Joanna, Roszkowski-Śliż, Kazimierz
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.09.2017; Public Library of Science (PLoS)
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Anti-Bacterial Agents - therapeutic use; Antibiotics; Asthma; Biology and Life Sciences; Biopsy; Clarithromycin; Clarithromycin - therapeutic use; Comparative analysis; Complications and side effects; Corticoids; Corticosteroids; Cryptogenic Organizing Pneumonia - drug therapy; Cryptogenic Organizing Pneumonia - pathology; Cytokines; Dosage and administration; Drug therapy; Family medical history; Female; Geriatrics; Humans; Hypersensitivity; Immunoglobulins; Lesions; Lung - pathology; Lung diseases; Male; Medical services; Medicine and Health Sciences; Middle Aged; Observational studies; Patients; Physical Sciences; Pneumonia; Prednisone; Pulmonary functions; Radiation therapy; Research and Analysis Methods; Respiratory function; Retrospective Studies; Sensitivity; Therapy; Thoracic surgery; Thyroid gland; Tuberculosis; Tumor necrosis factor-TNF; Poland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0184739

Cryptogenic organizing pneumonia (COP) is a clinicopathological syndrome of unknown origin. Corticosteroids are the standard treatment, but clarithromycin (CAM) is also effective. The aim of this observational retrospective study was to compare the results of CAM versus prednisone (PRE) treatment in patients with biopsy-proven OP without respiratory insufficiency. In a 15-year period, 40 patients were treated with CAM (500 mg twice daily orally for 3 months) and 22 with PRE (mean initial dose of 0.67 ± 0.24 mg/kg/d for a mean of 8.59 ± 3.05 months). The clinical presentation, laboratory, and radiological findings did not differ markedly between patients treated with CAM and PRE, with the exception of a higher frequency of sweats (55% vs. 23%; p < 0.015), ground glass opacities (95% vs. 50%; p <0.0001) and nodular lesions (45% vs. 18%; p = 0.036) in the CAM group. A complete response was achieved in 35(88%) patients treated with CAM and in all treated with PRE. Patients treated with PRE relapsed more frequently than those treated with CAM (54.5% vs. 10%; p < 0.0001). Corticosteroid-related adverse events were noticed in 8(6.5%) patients (with one death), but CAM caused only one (2.5%) allergic reaction. A FVC >80% identified patients who might be successfully treated with CAM with a sensitivity of 60% and a specificity of 88.57% (AUC 0.869; 95% CI 0.684-1; p = 0.008); the figures for the FEV1 were >70%, a sensitivity of 60%, and a specificity of 91.43% (AUC 0.809; 95%CI 0.609-1; p = 0.027). CAM can be used to treat COP patients in whom the pulmonary function parameters are within normal limits. Such therapy is shorter, better tolerated, and associated with fewer adverse events and relapses than is PRE. However, the therapy is ineffective in some patients.