Add-on azithromycin reduces sputum cytokines in non-eosinophilic asthma: an AMAZES substudy

Shakti D Shukla; Steven L Taylor; Peter G Gibson; Daniel Barker; John W Upham; Ian A Yang; Paul N Reynolds; Sandra Hodge; Alan L James; Geraint B Rogers; Jodie L Simpson

doi:10.1136/thoraxjnl-2020-216331

Add-on azithromycin reduces sputum cytokines in non-eosinophilic asthma: an AMAZES substudy

Thorax. 2021 Jul;76(7):733-736. doi: 10.1136/thoraxjnl-2020-216331. Epub 2021 Jan 7.

Authors

Shakti D Shukla¹, Steven L Taylor^{2

3}, Peter G Gibson^{1

4}, Daniel Barker¹, John W Upham^{5

6}, Ian A Yang^{5

7}, Paul N Reynolds^{8

9}, Sandra Hodge^{8

9}, Alan L James^{10

11}, Geraint B Rogers^{2

3}, Jodie L Simpson^{12

4}

Affiliations

¹ Faculty of Health and Medicine, The University of Newcastle Priority Research Centre for Asthma and Respiratory Disease, Newcastle, New South Wales, Australia.
² Microbiome and Host Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
³ SAHMRI Microbiome Research Laboratory, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
⁴ Hunter Medical Research Institute, Newcastle, NSW, Australia.
⁵ Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
⁶ Translational Research Institute, Brisbane, QLD, Australia.
⁷ Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.
⁸ Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁹ School of Medicine, University of Adelaide, Adelaide, SA, Australia.
¹⁰ Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
¹¹ Medicine School, University of Western Australia, Crawley, WA, Australia.
¹² Faculty of Health and Medicine, The University of Newcastle Priority Research Centre for Asthma and Respiratory Disease, Newcastle, New South Wales, Australia jodie.simpson@newcastle.edu.au.

PMID: 33414242
DOI: 10.1136/thoraxjnl-2020-216331

Abstract

Add-on azithromycin (AZM) significantly reduces exacerbations in poorly controlled asthma irrespective of disease phenotype. In a predefined substudy of the original AMAZES protocol (500 mg, three times a week for 48 weeks), we report that AZM treatment reduces key sputum inflammatory proteins (interleukin (IL)-6, IL-1β and extracellular DNA), which is more evident in non-eosinophilic asthma (NEA). Moreover, AZM reduced Haemophilus influenzae load only in NEA. Our data support the anti-inflammatory effects of AZM in poorly controlled asthma. Prospective studies are required to identify patients that derive greatest benefit from AZM add-on therapy.

Keywords: asthma; asthma pharmacology; cytokine biology; respiratory infection.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Anti-Bacterial Agents / therapeutic use
Asthma / drug therapy*
Asthma / metabolism
Azithromycin / administration & dosage*
Cytokines / metabolism*
Humans
Prospective Studies
Sputum / metabolism*

Substances

Anti-Bacterial Agents
Cytokines
Azithromycin