Double-blind, placebo-controlled, randomized trial on low-dose azithromycin prophylaxis in patients with primary antibody deficiencies

Cinzia Milito, Federica Pulvirenti, Francesco Cinetto, Vassilios Lougaris, Annarosa Soresina, Antonio Pecoraro, Alessandra Vultaggio, Maria Carrabba, Giuseppe Lassandro, Alessandro Plebani, Giuseppe Spadaro, Andrea Matucci, Giovanna Fabio, Rosa Maria Dellepiane, Baldassarre Martire, Carlo Agostini, Damiano Abeni, Stefano Tabolli, Isabella Quinti

Research output: Contribution to journalArticle

Abstract

Background: Lacking protective antibodies, patients with primary antibody deficiencies (PADs) experience frequent respiratory tract infections, leading to chronic pulmonary damage. Macrolide prophylaxis has proved effective in patients with chronic respiratory diseases. Objective: We aimed to test the efficacy and safety of orally administered low-dose azithromycin prophylaxis in patients with PADs. Methods: We designed a 3-year, double-blind, placebo-controlled, randomized clinical trial to test whether oral azithromycin (250 mg administered once daily 3 times a week for 2 years) would reduce respiratory exacerbations in patients with PADs and chronic infection–related pulmonary diseases. The primary end point was the number of annual respiratory exacerbations. Secondary end points included time to first exacerbation, additional antibiotic courses, number of hospitalizations, and safety. Results: Eighty-nine patients received azithromycin (n = 44) or placebo (n = 45). The number of exacerbations was 3.6 (95% CI, 2.5-4.7) per patient-year in the azithromycin arm and 5.2 (95% CI, 4.1-6.4) per patient-year in the placebo arm (P =.02). In the azithromycin group the hazard risk for having an acute exacerbation was 0.5 (95% CI, 0.3-0.9; P =.03), and the hazard risk for hospitalization was 0.5 (95% CI, 0.2-1.1; P =.04). The rate of additional antibiotic treatment per patient-year was 2.3 (95% CI, 2.1-3.4) in the intervention group and 3.6 (95% CI, 2.9-4.3) in the placebo group (P =.004). Haemophilus influenzae and Streptococcus pneumoniae were the prevalent isolates, and they were not susceptible to macrolides in 25% of patients of both arms. Azithromycin's safety profile was comparable with that of placebo. Conclusion: The study reached the main outcome centered on the reduction of exacerbation episodes per patient-year, with a consequent reduction in additional courses of antibiotics and risk of hospitalization.

Original languageEnglish
Pages (from-to)584-593.e7
JournalJournal of Allergy and Clinical Immunology
Volume144
Issue number2
DOIs
Publication statusPublished - Jan 1 2019

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Keywords

  • antibiotic prophylaxis
  • azithromycin
  • chronic obstructive pulmonary disease
  • Primary antibody defects
  • respiratory exacerbation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Milito, C., Pulvirenti, F., Cinetto, F., Lougaris, V., Soresina, A., Pecoraro, A., Vultaggio, A., Carrabba, M., Lassandro, G., Plebani, A., Spadaro, G., Matucci, A., Fabio, G., Dellepiane, R. M., Martire, B., Agostini, C., Abeni, D., Tabolli, S., & Quinti, I. (2019). Double-blind, placebo-controlled, randomized trial on low-dose azithromycin prophylaxis in patients with primary antibody deficiencies. Journal of Allergy and Clinical Immunology, 144(2), 584-593.e7. https://doi.org/10.1016/j.jaci.2019.01.051