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

Lotte C. Terpstra; Josje Altenburg; Firdaus A. Mohamed Hoesein; Inez Bronsveld; Shirley Go; Philip A. C. van Rijn; Pim A. de Jong; Harry G. M. Heijerman; Wim G. Boersma

doi:10.1016/j.rmed.2021.106718

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

Lotte C. Terpstra^*
, Josje Altenburg
, Firdaus A. Mohamed Hoesein
, Inez Bronsveld
, Shirley Go
, Philip A. C. van Rijn
, Pim A. de Jong
, Harry G. M. Heijerman
, Wim G. Boersma

^*Corresponding author for this work

Department of Clinical Chemistry, Haematology & Immunology,Northwest Clinics, Alkmaar, The Netherlands
University Medical Center Utrecht
Department of Cardiology, Slingeland Hospital, Doetinchem, The Netherlands
Haematology & Immunology,Northwest Clinics
Amsterdam University Medical Centers
Utrecht University
Slingeland Hospital

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Rationale: 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. Methods: 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. Results: 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)). Conclusions: 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.

Original language	English
Article number	106718
Pages (from-to)	106718
Journal	Respiratory medicine
Volume	192
Early online date	28 Dec 2021
DOIs	https://doi.org/10.1016/j.rmed.2021.106718
Publication status	Published - 1 Feb 2022

Keywords

Azithromycin (AZM)
Bronchiectasis
High resolution computed tomography (HRCT)
Immunomodulation
Radiology

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The-effect-of-maintenance-azithromycin-on-radiological-features-in-patients-with-bronchiectasis---analysis-from-the-bat-.pdfFinal published version, 1.75 MBLicence: Taverne

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Terpstra, L. C., Altenburg, J., Mohamed Hoesein, F. A., Bronsveld, I., Go, S., van Rijn, P. A. C., de Jong, P. A., Heijerman, H. G. M., & Boersma, W. G. (2022). The effect of maintenance azithromycin on radiological features in patients with bronchiectasis - Analysis from the BAT randomized controlled trial. Respiratory medicine, 192, 106718. Article 106718. https://doi.org/10.1016/j.rmed.2021.106718

@article{e243d85e3487440a89056fa737e16677,

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

abstract = "Rationale: 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. Methods: 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. Results: 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)). Conclusions: 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.",

keywords = "Azithromycin (AZM), Bronchiectasis, High resolution computed tomography (HRCT), Immunomodulation, Radiology",

author = "Terpstra, \{Lotte C.\} and Josje Altenburg and \{Mohamed Hoesein\}, \{Firdaus A.\} and Inez Bronsveld and Shirley Go and \{van Rijn\}, \{Philip A. C.\} and \{de Jong\}, \{Pim A.\} and Heijerman, \{Harry G. M.\} and Boersma, \{Wim G.\}",

note = "Funding Information: For the BAT study, J. Altenburg and W.G. Boersma were supported by a research grant from the Northwest Academy , an independent scientific institution based in the Northwest Clinics location Alkmaar. This grant was used for paying salaries for the main researcher and research assistant, to provide logistical support, and for laboratory tests, pulmonary function testing, and imaging. The BAT study was supported by an unrestricted research grant from GlaxoSmithKline and Chiesi (2016). Teva Netherlands supplied the azithromycin tablets used in the study. No salaries or stipends were paid. Publisher Copyright: {\textcopyright} 2021 Elsevier Ltd",

year = "2022",

month = feb,

day = "1",

doi = "10.1016/j.rmed.2021.106718",

language = "English",

volume = "192",

pages = "106718",

journal = "Respiratory medicine",

issn = "0954-6111",

publisher = "W.B. Saunders Ltd",

}

Terpstra, LC, Altenburg, J, Mohamed Hoesein, FA, Bronsveld, I, Go, S, van Rijn, PAC, de Jong, PA, Heijerman, HGM & Boersma, WG 2022, 'The effect of maintenance azithromycin on radiological features in patients with bronchiectasis - Analysis from the BAT randomized controlled trial', Respiratory medicine, vol. 192, 106718, pp. 106718. https://doi.org/10.1016/j.rmed.2021.106718

The effect of maintenance azithromycin on radiological features in patients with bronchiectasis - Analysis from the BAT randomized controlled trial. / Terpstra, Lotte C.; Altenburg, Josje; Mohamed Hoesein, Firdaus A. et al.
In: Respiratory medicine, Vol. 192, 106718, 01.02.2022, p. 106718.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The effect of maintenance azithromycin on radiological features in patients with bronchiectasis - Analysis from the BAT randomized controlled trial

AU - Terpstra, Lotte C.

AU - Altenburg, Josje

AU - Mohamed Hoesein, Firdaus A.

AU - Bronsveld, Inez

AU - Go, Shirley

AU - van Rijn, Philip A. C.

AU - de Jong, Pim A.

AU - Heijerman, Harry G. M.

AU - Boersma, Wim G.

N1 - Funding Information: For the BAT study, J. Altenburg and W.G. Boersma were supported by a research grant from the Northwest Academy , an independent scientific institution based in the Northwest Clinics location Alkmaar. This grant was used for paying salaries for the main researcher and research assistant, to provide logistical support, and for laboratory tests, pulmonary function testing, and imaging. The BAT study was supported by an unrestricted research grant from GlaxoSmithKline and Chiesi (2016). Teva Netherlands supplied the azithromycin tablets used in the study. No salaries or stipends were paid. Publisher Copyright: © 2021 Elsevier Ltd

PY - 2022/2/1

Y1 - 2022/2/1

N2 - Rationale: 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. Methods: 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. Results: 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)). Conclusions: 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.

AB - Rationale: 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. Methods: 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. Results: 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)). Conclusions: 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.

KW - Azithromycin (AZM)

KW - Bronchiectasis

KW - High resolution computed tomography (HRCT)

KW - Immunomodulation

KW - Radiology

UR - https://www.scopus.com/pages/publications/85122057073

U2 - 10.1016/j.rmed.2021.106718

DO - 10.1016/j.rmed.2021.106718

M3 - Article

C2 - 34974413

SN - 0954-6111

VL - 192

SP - 106718

JO - Respiratory medicine

JF - Respiratory medicine

M1 - 106718

ER -

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

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Keywords

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