A trial of clarithromycin for the treatment of suboptimally controlled asthma

E. Rand Sutherland, Tonya S. King, Nikolina Icitovic, Bill Ameredes, Eugene Bleecker, Homer A. Boushey, William Calhoun, Mario Castro, Reuben M. Cherniack, Vernon M. Chinchilli, Timothy J. Craig, Loren Denlinger, Emily A. Dimango, John V. Fahy, Elliot Israel, Nizar Jarjour, Monica Kraft, Stephen C. Lazarus, Robert F. Lemanske, Stephen P. Peters & 8 others Joe Ramsdell, Christine A. Sorkness, Stanley J. Szefler, Michael J. Walter, Stephen I. Wasserman, Michael E. Wechsler, Hong Wei Chu, Richard J. Martin

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

Background: PCR studies have demonstrated evidence of Mycoplasma pneumoniae and Chlamydophila pneumoniae in the lower airways of patients with asthma. Objective: To test the hypothesis that clarithromycin would improve asthma control in individuals with mild-to-moderate persistent asthma that was not well controlled despite treatment with low-dose inhaled corticosteroids. Methods: Adults with an Asthma Control Questionnaire score ≥1.5 after a 4-week period of treatment with fluticasone propionate were entered into a PCR-stratified randomized, controlled trial to evaluate the effect of 16 weeks of either clarithromycin or placebo, added to fluticasone, on asthma control in individuals with or without lower airway PCR evidence of M pneumoniae or C pneumoniae. Results: A total of 92 participants were randomized. Twelve (13%) subjects demonstrated PCR evidence of M pneumoniae or C pneumoniae in endobronchial biopsies; 80 were PCR-negative for both organisms. In PCR-positive participants, clarithromycin yielded a 0.4 ± 0.4 unit improvement in the Asthma Control Questionnaire score, with a 0.1 ± 0.3 unit improvement in those allocated to placebo. This between-group difference of 0.3 ± 0.5 (P = .6) was neither clinically nor statistically significant. In PCR-negative participants, a nonsignificant between-group difference of 0.2 ± 0.2 units (P = .3) was observed. Clarithromycin did not improve lung function or airway inflammation but did improve airway hyperresponsiveness, increasing the methacholine PC20 by 1.2 ± 0.5 doubling doses (P = .02) in the study population. Conclusion: Adding clarithromycin to fluticasone in adults with mild-to-moderate persistent asthma that was suboptimally controlled by low-dose inhaled corticosteroids alone did not further improve asthma control. Although there was an improvement in airway hyperresponsiveness with clarithromycin, this benefit was not accompanied by improvements in other secondary outcomes.

Original languageEnglish (US)
Pages (from-to)747-753
Number of pages7
JournalJournal of Allergy and Clinical Immunology
Volume126
Issue number4
DOIs
StatePublished - Oct 2010

Fingerprint

Clarithromycin
Asthma
Polymerase Chain Reaction
Pneumonia
Therapeutics
Adrenal Cortex Hormones
Placebos
Chlamydophila pneumoniae
Mycoplasma pneumoniae
Methacholine Chloride
Randomized Controlled Trials
Inflammation
Biopsy
Lung

Keywords

  • antibiotic
  • Asthma
  • infection

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Sutherland, E. R., King, T. S., Icitovic, N., Ameredes, B., Bleecker, E., Boushey, H. A., ... Martin, R. J. (2010). A trial of clarithromycin for the treatment of suboptimally controlled asthma. Journal of Allergy and Clinical Immunology, 126(4), 747-753. https://doi.org/10.1016/j.jaci.2010.07.024

A trial of clarithromycin for the treatment of suboptimally controlled asthma. / Sutherland, E. Rand; King, Tonya S.; Icitovic, Nikolina; Ameredes, Bill; Bleecker, Eugene; Boushey, Homer A.; Calhoun, William; Castro, Mario; Cherniack, Reuben M.; Chinchilli, Vernon M.; Craig, Timothy J.; Denlinger, Loren; Dimango, Emily A.; Fahy, John V.; Israel, Elliot; Jarjour, Nizar; Kraft, Monica; Lazarus, Stephen C.; Lemanske, Robert F.; Peters, Stephen P.; Ramsdell, Joe; Sorkness, Christine A.; Szefler, Stanley J.; Walter, Michael J.; Wasserman, Stephen I.; Wechsler, Michael E.; Chu, Hong Wei; Martin, Richard J.

In: Journal of Allergy and Clinical Immunology, Vol. 126, No. 4, 10.2010, p. 747-753.

Research output: Contribution to journalArticle

Sutherland, ER, King, TS, Icitovic, N, Ameredes, B, Bleecker, E, Boushey, HA, Calhoun, W, Castro, M, Cherniack, RM, Chinchilli, VM, Craig, TJ, Denlinger, L, Dimango, EA, Fahy, JV, Israel, E, Jarjour, N, Kraft, M, Lazarus, SC, Lemanske, RF, Peters, SP, Ramsdell, J, Sorkness, CA, Szefler, SJ, Walter, MJ, Wasserman, SI, Wechsler, ME, Chu, HW & Martin, RJ 2010, 'A trial of clarithromycin for the treatment of suboptimally controlled asthma', Journal of Allergy and Clinical Immunology, vol. 126, no. 4, pp. 747-753. https://doi.org/10.1016/j.jaci.2010.07.024
Sutherland, E. Rand ; King, Tonya S. ; Icitovic, Nikolina ; Ameredes, Bill ; Bleecker, Eugene ; Boushey, Homer A. ; Calhoun, William ; Castro, Mario ; Cherniack, Reuben M. ; Chinchilli, Vernon M. ; Craig, Timothy J. ; Denlinger, Loren ; Dimango, Emily A. ; Fahy, John V. ; Israel, Elliot ; Jarjour, Nizar ; Kraft, Monica ; Lazarus, Stephen C. ; Lemanske, Robert F. ; Peters, Stephen P. ; Ramsdell, Joe ; Sorkness, Christine A. ; Szefler, Stanley J. ; Walter, Michael J. ; Wasserman, Stephen I. ; Wechsler, Michael E. ; Chu, Hong Wei ; Martin, Richard J. / A trial of clarithromycin for the treatment of suboptimally controlled asthma. In: Journal of Allergy and Clinical Immunology. 2010 ; Vol. 126, No. 4. pp. 747-753.
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abstract = "Background: PCR studies have demonstrated evidence of Mycoplasma pneumoniae and Chlamydophila pneumoniae in the lower airways of patients with asthma. Objective: To test the hypothesis that clarithromycin would improve asthma control in individuals with mild-to-moderate persistent asthma that was not well controlled despite treatment with low-dose inhaled corticosteroids. Methods: Adults with an Asthma Control Questionnaire score ≥1.5 after a 4-week period of treatment with fluticasone propionate were entered into a PCR-stratified randomized, controlled trial to evaluate the effect of 16 weeks of either clarithromycin or placebo, added to fluticasone, on asthma control in individuals with or without lower airway PCR evidence of M pneumoniae or C pneumoniae. Results: A total of 92 participants were randomized. Twelve (13{\%}) subjects demonstrated PCR evidence of M pneumoniae or C pneumoniae in endobronchial biopsies; 80 were PCR-negative for both organisms. In PCR-positive participants, clarithromycin yielded a 0.4 ± 0.4 unit improvement in the Asthma Control Questionnaire score, with a 0.1 ± 0.3 unit improvement in those allocated to placebo. This between-group difference of 0.3 ± 0.5 (P = .6) was neither clinically nor statistically significant. In PCR-negative participants, a nonsignificant between-group difference of 0.2 ± 0.2 units (P = .3) was observed. Clarithromycin did not improve lung function or airway inflammation but did improve airway hyperresponsiveness, increasing the methacholine PC20 by 1.2 ± 0.5 doubling doses (P = .02) in the study population. Conclusion: Adding clarithromycin to fluticasone in adults with mild-to-moderate persistent asthma that was suboptimally controlled by low-dose inhaled corticosteroids alone did not further improve asthma control. Although there was an improvement in airway hyperresponsiveness with clarithromycin, this benefit was not accompanied by improvements in other secondary outcomes.",
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T1 - A trial of clarithromycin for the treatment of suboptimally controlled asthma

AU - Sutherland, E. Rand

AU - King, Tonya S.

AU - Icitovic, Nikolina

AU - Ameredes, Bill

AU - Bleecker, Eugene

AU - Boushey, Homer A.

AU - Calhoun, William

AU - Castro, Mario

AU - Cherniack, Reuben M.

AU - Chinchilli, Vernon M.

AU - Craig, Timothy J.

AU - Denlinger, Loren

AU - Dimango, Emily A.

AU - Fahy, John V.

AU - Israel, Elliot

AU - Jarjour, Nizar

AU - Kraft, Monica

AU - Lazarus, Stephen C.

AU - Lemanske, Robert F.

AU - Peters, Stephen P.

AU - Ramsdell, Joe

AU - Sorkness, Christine A.

AU - Szefler, Stanley J.

AU - Walter, Michael J.

AU - Wasserman, Stephen I.

AU - Wechsler, Michael E.

AU - Chu, Hong Wei

AU - Martin, Richard J.

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N2 - Background: PCR studies have demonstrated evidence of Mycoplasma pneumoniae and Chlamydophila pneumoniae in the lower airways of patients with asthma. Objective: To test the hypothesis that clarithromycin would improve asthma control in individuals with mild-to-moderate persistent asthma that was not well controlled despite treatment with low-dose inhaled corticosteroids. Methods: Adults with an Asthma Control Questionnaire score ≥1.5 after a 4-week period of treatment with fluticasone propionate were entered into a PCR-stratified randomized, controlled trial to evaluate the effect of 16 weeks of either clarithromycin or placebo, added to fluticasone, on asthma control in individuals with or without lower airway PCR evidence of M pneumoniae or C pneumoniae. Results: A total of 92 participants were randomized. Twelve (13%) subjects demonstrated PCR evidence of M pneumoniae or C pneumoniae in endobronchial biopsies; 80 were PCR-negative for both organisms. In PCR-positive participants, clarithromycin yielded a 0.4 ± 0.4 unit improvement in the Asthma Control Questionnaire score, with a 0.1 ± 0.3 unit improvement in those allocated to placebo. This between-group difference of 0.3 ± 0.5 (P = .6) was neither clinically nor statistically significant. In PCR-negative participants, a nonsignificant between-group difference of 0.2 ± 0.2 units (P = .3) was observed. Clarithromycin did not improve lung function or airway inflammation but did improve airway hyperresponsiveness, increasing the methacholine PC20 by 1.2 ± 0.5 doubling doses (P = .02) in the study population. Conclusion: Adding clarithromycin to fluticasone in adults with mild-to-moderate persistent asthma that was suboptimally controlled by low-dose inhaled corticosteroids alone did not further improve asthma control. Although there was an improvement in airway hyperresponsiveness with clarithromycin, this benefit was not accompanied by improvements in other secondary outcomes.

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