Academic Journal
أعرض في EDS

Treatment failure and hospital readmissions in severe COPD exacerbations treated with azithromycin versus placebo - A post-hoc analysis of the BACE randomized controlled trial

التفاصيل البيبلوغرافية
العنوان: Treatment failure and hospital readmissions in severe COPD exacerbations treated with azithromycin versus placebo - A post-hoc analysis of the BACE randomized controlled trial
المؤلفون: Vermeersch, K., Belmans, A., Bogaerts, K., Gyselinck, I., Cardinaels, N., Gabrovska, M., Aumann, J., Demedts, I. K., Corhay, Jean-Louis, Marchand, E., Slabbynck, H., Haenebalcke, C., Vermeersch, S., Verleden, G. M., Troosters, T., Ninane, V., Brusselle, G. G., Janssens, W., Peché, R., Vincken, W., Haerens, M., Fremault, A., Lauwerier, T., Debrock, A., Lamont, J., Tits, G., Jordens, P., Delobbe, A., Martinot, J.-B.
المصدر: Respiratory Research, 20 (1), 237 (2019)
بيانات النشر: BioMed Central Ltd.
سنة النشر: 2019
المجموعة: University of Liège: ORBi (Open Repository and Bibliography)
مصطلحات موضوعية: CRP, Eosinophil count, Macrolide, Readmission, Recurrent event, Human health sciences, Cardiovascular & respiratory systems, Sciences de la santé humaine, Systèmes cardiovasculaire & respiratoire
الوصف: peer reviewed ; Background: In the BACE trial, a 3-month (3 m) intervention with azithromycin, initiated at the onset of an infectious COPD exacerbation requiring hospitalization, decreased the rate of a first treatment failure (TF); the composite of treatment intensification (TI), step-up in hospital care (SH) and mortality. Objectives: (1) To investigate the intervention's effect on recurrent events, and (2) to identify clinical subgroups most likely to benefit, determined from the incidence rate of TF and hospital readmissions. Methods: Enrolment criteria included the diagnosis of COPD, a smoking history of ≥10 pack-years and ≥ 1 exacerbation in the previous year. Rate ratio (RR) calculations, subgroup analyses and modelling of continuous variables using splines were based on a Poisson regression model, adjusted for exposure time. Results: Azithromycin significantly reduced TF by 24% within 3 m (RR = 0.76, 95%CI:0.59;0.97, p = 0.031) through a 50% reduction in SH (RR = 0.50, 95%CI:0.30;0.81, p = 0.006), which comprised of a 53% reduction in hospital readmissions (RR = 0.47, 95%CI:0.27;0.80; p = 0.007). A significant interaction between the intervention, CRP and blood eosinophil count at hospital admission was found, with azithromycin significantly reducing hospital readmissions in patients with high CRP (> 50 mg/L, RR = 0.18, 95%CI:0.05;0.60, p = 0.005), or low blood eosinophil count (<300cells/μL, RR = 0.33, 95%CI:0.17;0.64, p = 0.001). No differences were observed in treatment response by age, FEV1, CRP or blood eosinophil count in continuous analyses. Conclusions: This post-hoc analysis of the BACE trial shows that azithromycin initiated at the onset of an infectious COPD exacerbation requiring hospitalization reduces the incidence rate of TF within 3 m by preventing hospital readmissions. In patients with high CRP or low blood eosinophil count at admission this treatment effect was more pronounced, suggesting a potential role for these biomarkers in guiding azithromycin therapy. Trial registration: ...
نوع الوثيقة: article in journal/newspaper
اللغة: English
تدمد: 1465-9921
1465-993X
Relation: urn:issn:1465-9921; urn:issn:1465-993X; https://orbi.uliege.be/handle/2268/256072; info:hdl:2268/256072; https://orbi.uliege.be/bitstream/2268/256072/1/VERMEERSCH%202019_Treatment%20failure_respir%20Res_ppediteur.pdf; info:pmid:31665017
DOI: 10.1186/s12931-019-1208-6
الاتاحة: https://orbi.uliege.be/handle/2268/256072
https://orbi.uliege.be/bitstream/2268/256072/1/VERMEERSCH%202019_Treatment%20failure_respir%20Res_ppediteur.pdf
https://doi.org/10.1186/s12931-019-1208-6
Rights: open access ; http://purl.org/coar/access_right/c_abf2 ; info:eu-repo/semantics/openAccess
رقم الانضمام: edsbas.A18150CB
قاعدة البيانات: BASE
الوصف
تدمد:14659921
1465993X
DOI:10.1186/s12931-019-1208-6