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Azithromycin for sarcoidosis cough: an open label exploratory clinical trial

Fraser, Simon D.; Thackray-Nocera, Susannah; Shepherd, Marica; Flockton, Rachel; Wright, Caroline; Sheedy, Wayne; Brindle, Kayleigh; Morice, Alyn H.; Kaye, Paul M.; Crooks, Michael G.; Hart, Simon P.

Authors

Simon D. Fraser

Susannah Thackray-Nocera

Marica Shepherd

Rachel Flockton

Caroline Wright

Kayleigh Brindle

Paul M. Kaye

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Dr Michael Crooks m.g.crooks@hull.ac.uk
Senior Clinical Lecturer in Respiratory Medicine



Abstract

Background Chronic cough is a distressing symptom for many people with pulmonary sarcoidosis. Continuous treatment with a macrolide antibiotic may improve cough. We aimed to assess the potential efficacy of azithromycin in patients with sarcoidosis and self-reported cough.

Methods We did a non-controlled, open label clinical trial of azithromycin 250 mg once daily for 3 months in patients with pulmonary sarcoidosis who reported a chronic cough. The primary outcome was number of coughs in 24 h. Secondary outcomes were cough visual analog scales and quality of life measured using the Leicester Cough Questionnaire and King's Sarcoidosis Questionnaire. Safety outcomes included QTc interval on ECG. Measurements were made at baseline and after one and 3 months of treatment.

Results All 21 patients were white, median age 57 years, 9 males/12 females, median 3 years since diagnosis. Five were taking oral corticosteroids and none were taking other immunosuppressants. Twenty patients completed the trial. The median (range) number of coughs in 24 h was 228 (43–1950) at baseline, 122 (20–704) at 1 month, and 81 (16–414) at 3 months (p=0.002, Friedman's test). The median reduction in cough count at 3 months was 49.6%. There were improvements in all patient-reported outcomes. Azithromycin was well tolerated.

Conclusion In a non-controlled open-label trial in people with sarcoidosis who reported a chronic cough, 3 months of treatment with azithromycin led to improvements in a range of cough metrics. Azithromycin should be tested as a treatment for sarcoidosis cough in a randomised placebo-controlled trial.

Citation

Fraser, S. D., Thackray-Nocera, S., Shepherd, M., Flockton, R., Wright, C., Sheedy, W., …Hart, S. P. (2020). Azithromycin for sarcoidosis cough: an open label exploratory clinical trial. ERJ Open Research, 6(4), https://doi.org/10.1183/23120541.00534-2020

Journal Article Type Article
Acceptance Date Sep 9, 2020
Online Publication Date Nov 10, 2020
Publication Date Oct 1, 2020
Deposit Date Oct 17, 2020
Publicly Available Date Oct 19, 2020
Journal ERJ Open Research
Publisher European Respiratory Society
Peer Reviewed Peer Reviewed
Volume 6
Issue 4
Article Number 00534
DOI https://doi.org/10.1183/23120541.00534-2020
Keywords Cough; Sarcoidosis
Public URL https://hull-repository.worktribe.com/output/3644050
Publisher URL https://openres.ersjournals.com/content/early/2020/09/17/23120541.00534-2020

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Publisher Licence URL
http://creativecommons.org/licenses/by-nc/4.0

Copyright Statement
Copyright ©ERS 2020. http://creativecommons.org/licenses/by-nc/4.0/
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.






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