title: Azithromycin for the Treatment of Obliterative Bronchiolitis after Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis.
abstract: Obliterative bronchiolitis (OB) is a major cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). Our objective was to perform a systematic review and meta-analysis of the impact of azithromycin on change in forced expiratory volume in 1 second (FEV1). We searched MEDLINE, EMBASE, Web of Science, Cochrane CENTRAL and Scopus databases and included studies that compared azithromycin with placebo or no intervention in the treatment of OB or bronchiolitis obliterans syndrome (BOS) in patients who had undergone allogeneic HSCT. Ninety-one unique publications were identified, and 4 studies met inclusion criteria, with a total of 90 patients. Changes in FEV1were measured between 12 and 24 weeks after initiation of treatment. The meta-analysis demonstrated a mean increase in FEV1of 30 mL (95% confidence interval, -260 to +330 mL; P = .82) after initiation of azithromycin. One patient death was reported but not attributed to azithromycin therapy. In conclusion, current evidence can neither support nor refute the use of azithromycin in the treatment of patients who develop OB/BOS after HSCT. Further studies are needed to determine whether azithromycin is beneficial for the treatment of OB/BOS in this setting.
authors: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: yadav.hemang@mayo.edu.
authors: Hemang
authors: H
authors: Yadav
authors: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota.
authors: Steve G
authors: SG
authors: Peters
authors: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
authors: Karina A
authors: KA
authors: Keogh
authors: Division of Hematology, Mayo Clinic, Rochester, Minnesota.
authors: William J
authors: WJ
authors: Hogan
authors: Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota.
authors: Patricia J
authors: PJ
authors: Erwin
authors: Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors: Colin P
authors: CP
authors: West
authors: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota.
authors: Cassie C
authors: CC
authors: Kennedy
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D017963:Azithromycin / Q000494:pharmacology / Q000627:therapeutic use*; D001989:Bronchiolitis Obliterans / Q000188:drug therapy* / Q000209:etiology; D005541:Forced Expiratory Volume / Q000187:drug effects; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin
keywords: Allogeneic; Bone marrow transplant; Bronchiolitis obliterans; Hematopoietic stem cell transplantation; Obliterative bronchiolitis