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

doi:10.1136/thoraxjnl-2020-216331

Review

. 2021 Jul;76(7):733-736.

doi: 10.1136/thoraxjnl-2020-216331. Epub 2021 Jan 7.

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

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

Review

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

Shakti D Shukla et al. Thorax. 2021 Jul.

. 2021 Jul;76(7):733-736.

doi: 10.1136/thoraxjnl-2020-216331. Epub 2021 Jan 7.

Authors

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.

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Conflict of interest statement

Competing interests: JWU reports personal fees from AstraZeneca, personal fees from GSK, personal fees from Novartis, personal fees from Boehringer Ingelheim, personal fees from Sanofi, outside the submitted work. PGG reports personal fees from AstraZeneca, GlaxoSmithKline, Novartis, grants from AstraZeneca, GlaxoSmithKline, outside the submitted work.

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

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

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