Azithromycin in the Management of Patients With Acute Exacerbation of Idiopathic Pulmonary Fibrosis

Idiopathic Pulmonary Fibrosis Clinical Trial

Official title:

Role of Add-on Azithromycin in the Management of Patients With Acute Exacerbation of Idiopathic Pulmonary Fibrosis

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT05842681
• Other study ID #: 2516771716
• Status: Not yet recruiting
• Phase: N/A
• Start date: June 1, 2023
• Est. completion date: June 1, 2024

Study information

• Verified date: May 2023
• Source: Assiut University
• Contact: ahmad M shaddad, MD
• Phone: 01111171930
• Email: shaddad_ahmad[@]yahoo.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The study will assess the role of using azithromycin in managing acute exacerbation of Idiopathic pulmonary fibrosis

Description:

Idiopathic pulmonary fibrosis (IPF) is a progressive and irreversible fibrotic lung disease with a variable disease course. Most patients with IPF have a relatively slow clinical course, but up to 15% of patients experience an acute exacerbation of IPF (AE-IPF) each year, defined as an acute worsening or development of dyspnea and new bilateral ground-glass abnormality and/or consolidation on high-resolution computed tomography (HRCT). A recent epidemiologic survey of Japanese patients with IPF showed that the most common cause of death was AE-IPF.

The outcome of AE-IPF is very poor. The reported 1-month mortality rate is approximately 60%, and the reported in-hospital mortality rate ranges from 50 to 60%.

AE-IPF lacks an effective pharmaceutical treatment. Current guidelines recommend that most patients with AE-IPF should be treated with corticosteroids, but no controlled trials support this recommendation. The International Working Group recently proposed a revised definition and diagnostic criteria for AE-IPF. Previous diagnostic criteria. recommended the strict exclusion of other causes of acute worsening of respiratory disease, but new criteria have permitted physicians to include patients with triggered AE in addition to idiopathic AE-IPF.

In studies of the treatment and outcomes of AE-IPF, almost all patients received empirical antibiotics in addition to corticosteroids despite the lack of controlled trials showing the benefit of empirical treatment.

Azithromycin is a macrolide with immunomodulatory properties and anti-inflammatory effects. Previous reports have described the effectiveness of macrolides in patients with serious conditions, such as severe pneumonia and acute lung injury. Until 2011, erythromycin was the only macrolide that could be used by intravenous injection in Japan. Still, erythromycin has many side effects and drug interactions, so we did not routinely use intravenous erythromycin in daily clinical practice. In cases of suspected AE-IPF, we used quinolone-based antibiotics. Intravenous azithromycin has been approved for clinical use since September 2011 in Japan. Azithromycin is safer and easier to use than erythromycin, and since the publication of Walkey's report, we routinely use azithromycin for patients with acute respiratory failure since July 2012. We previously reported that intravenous azithromycin was associated with improved outcomes in patients with AE of chronic fibrosing interstitial pneumonia. However, that report had two major limitations: the very small number of patients treated with azithromycin and the inclusion of patients with nonspecific interstitial pneumonia and chronic hypersensitivity pneumonia.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 30
• Est. completion date: June 1, 2024
• Est. primary completion date: March 1, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Patients will be eligible for enrolment if diagnosed with Mild exacerbation of IPF and admitted to the Chest Department of Assiut University, requiring ventilator support without invasive mechanical ventilation.

Exclusion Criteria:

• Age: less than 18 years.

• Patients with any severity other than mild Acute exacerbation of IPF

• Patients with MSCT with a radiological pattern rather than UIP

• Unstable patients need mechanical ventilation or RICU admission

• Patients with end-organ failure.

Related Conditions & MeSH terms

• Fibrosis
• Idiopathic Pulmonary Fibrosis
• Pulmonary Fibrosis

Intervention

Drug:
• Azithromycin
A single daily oral dose of Azithromycin tablet 500 mg for five days
• Methylprednisolone
methylprednisolone 500 mg single intra-venous daily dose for three days

Locations

Country	Name	City	State
Egypt	Assiut university-Faculty of Medicine	Assiut

Sponsors (1)

Lead Sponsor	Collaborator
Assiut University

Country where clinical trial is conducted

Egypt, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Hospital stay	the main aime of the study to assess the hospital stay expressed in days in the Add-on Azithromycin 500 mg single oral daily dose in comparison to the conventional therapy group only	5-10 Days ( Days of Hospital admission until improvement and discharge)