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Treatment of Bronchiolitis Obliterans in Lung and Bone Marrow Transplant Recipients With Azithromycin: A Systematic Review and Meta-analysis FREE TO VIEW

Cassie Kennedy*, MD; Patricia Erwin; Karina Keogh, MD
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Mayo Clinic, Rochester, MN

Chest. 2012;142(4_MeetingAbstracts):1090A. doi:10.1378/chest.1390297
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SESSION TYPE: Lung Transplantation

PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM

PURPOSE: Bronchiolitis obliterans is a major cause of morbidity and mortality in lung and bone marrow transplantation. We sought to perform a systematic review and meta-analysis on the impact of azithromycin on forced expiratory volume in 1 second and survival in lung and bone marrow transplant recipients with bronchoilitis obliterans syndrome.

METHODS: Data sources: Web of Science, Scopus, MEDLINE, EMBASE, and Cochrane CENTRAL through Jan. 14, 2012. Eligibility: Observational or controlled trial. Participants: Lung or bone marrow transplant recipients. Intervention: Azithromycin. Study appraisal and synthesis methods: Study eligibility and data abstraction was performed independently and in duplicate (kappa=0.82). 141 unique publications were identified. 20 met inclusion criteria. Meta-analysis was performed on studies comparing patients after azithromycin treatment to baseline FEV1 using random effects model.

RESULTS: 7 studies including 144 patients reported mean difference from baseline FEV1 at 3 months with a pooled estimate of 0.32 L (0.17 to 0.48 L) p<0.001and I-squared of 60%. When 1 study with treatment duration less than 3 months was excluded mean difference in FEV1 was 0.25 L (0.14 to 0.37 L) with I-squared of 0% and p<0.001. Observational trials with comparison arm and controlled trials were inconsistently reported and therefore summarized qualitatively.

CONCLUSIONS: Azithromycin improves FEV1 at 3 months in patients with bronchiolitis obliterans syndrome.

CLINICAL IMPLICATIONS: Bone marrow and lung transplant patients with bronchiolitis obliterans syndrome should be treated with azithromycin.

DISCLOSURE: The following authors have nothing to disclose: Cassie Kennedy, Patricia Erwin, Karina Keogh

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Mayo Clinic, Rochester, MN




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