@article{046944cbd2264809ac3faeb24f2ce31f,
title = "A trial of clarithromycin for the treatment of suboptimally controlled asthma",
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.",
author = "Sutherland, {E. Rand} and King, {Tonya S.} and Nikolina Icitovic and Ameredes, {Bill T.} and Eugene Bleecker and Boushey, {Homer A.} and Calhoun, {William J.} and Mario Castro and Cherniack, {Reuben M.} and Chinchilli, {Vernon M.} and Craig, {Timothy J.} and Loren Denlinger and Dimango, {Emily A.} and Fahy, {John V.} and Elliot Israel and Nizar Jarjour and Monica Kraft and Lazarus, {Stephen C.} and Lemanske, {Robert F.} and Peters, {Stephen P.} and Joe Ramsdell and Sorkness, {Christine A.} and Szefler, {Stanley J.} and Walter, {Michael J.} and Wasserman, {Stephen I.} and Wechsler, {Michael E.} and Chu, {Hong Wei} and Martin, {Richard J.}",
note = "Funding Information: Disclosure of potential conflict of interest: E. R. Sutherland is an advisor and data and safety monitoring board member for GlaxoSmithKline, an advisor for Dey, LP, and a data and safety monitoring board member for Merck and has received research support from the National Institutes of Health, Novartis, and Boehringer-Ingelheim . E. Bleecker is an advisor/consultant for Aerovance, AstraZeneca, Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Merck, Novartis, Pfizer, and Wyeth and has received research support from Aerovance, Amgen, AstraZeneca, Boehringer-Ingelheim, Centocor, Ception, Genentech, GlaxoSmithKline, Novartis, Pfizer, Wyeth, and the National Institutes of Health . H. A. Boushey has consulted for KaloBios, has served on advisory committees for Pharmaxis and GlaxoSmithKline, and has received research support from GlaxoSmithKline . M. Castro, V. M. Chinchilli, and M. J. Walter have received research support from the National Institutes of Health . T. J. Craig has given talks for Teva, Merck, AstraZeneca, and Novartis and has received research support from GlaxoSmithKline, Boehringer-Ingelheim, Genentech, and Forest . J. V. Fahy has consulted for Amira, Cytokinetics, Abbott, GlaxoSmithKline, and Amgen and has received research support from Genentech and the National Institutes of Health . E. Israel has received research support from the National Institutes of Health and provided legal consultation or expert witness testimony on the subject of asthma. N. Jarjour has consulted for Asthmatx and Genentech and has received research support from GlaxoSmithKline, Merck, and MedImmune . M. Kraft, through Duke University, has received research support from Merck, GlaxoSmithKline, GE Healthcare, Biomark, and the National Institutes of Health . S. C. Lazarus and R. J. Martin have received research support from the National Heart, Lung, and Blood Institute . R. F. Lemanske, Jr, has given talks for Merck, Medicus Group, and the Fund for Medical Research and Education (Detroit); has consulted for Map Pharmaceuticals, Gray Consulting, Smith Research, Inc, Quintiles/Innovax, International Meetings and Science, and Scienomics; and has given talks and consulted for AstraZeneca. S. P. Peters has served on advisory boards and/or given talks for Abbott, AdvancMed, Asthmatx, AstraZeneca, Bristol-Meyers Squibb, Creative Educational Concepts, Dey, Dyson, Cephalon, Genentech, Integrity Continuing Education, MediCine, Merck, RAD Foundation, and Teva and has received research support from the National Institutes of Health, National Heart, Lung, and Blood Institute, and National Institute of Allergy and Infectious Diseases . C. A. Sorkness has served on advisory boards for GlaxoSmithKline, Schering-Plough, AstraZeneca, and Novartis and has received research support from Schering-Plough and Compleware/Sandoz . S. J. Szefler has consulted for GlaxoSmithKline, Genentech, Merck, Boehringer-Ingelheim, Novartis, and Schering-Plough and has received research support from the National Institutes of Health, National Heart, Lung, and Blood Institute, National Institute of Allergy and Infectious Diseases, GlaxoSmithKline, and National Institute of Environmental Health Sciences/Environmental Protection Agency . S. I. Wasserman has received research support from Merck , consulted for Schering, and provided legal consultation or expert witness testimony on the subject of mold allergy. The rest of the authors have declared that they have no conflict of interest. Funding Information: Supported by NIH/NHLBI U10 HL074227, 074231, 074204, 074212, 074073, 074206, 074208, 074225, 074218 , NIH/NHLBI K23 HL04385 , and NIH UL1-RR025011 . ",
year = "2010",
month = oct,
doi = "10.1016/j.jaci.2010.07.024",
language = "English (US)",
volume = "126",
pages = "747--753",
journal = "Journal of Allergy and Clinical Immunology",
issn = "0091-6749",
publisher = "Mosby Inc.",
number = "4",
}