Petitpierre Nicolas, Cottin Vincent, Marchand-Adam Sylvain, Hirschi Sandrine, Rigaud Dominique, Court-Fortune Isabelle, Jouneau Stéphane, Israël-Biet Dominique, Molard Anita, Cordier Jean-François, Lazor Romain
Interstitial and rare lung diseases Unit, Department of Respiratory Medicine, Lausanne University Hospital, Lausanne, Switzerland.
Department of Respiratory Medicine and Reference Center for rare lung diseases, Lyon University Hospital, Lyon, France.
Sarcoidosis Vasc Diffuse Lung Dis. 2018;35(3):230-238. doi: 10.36141/svdld.v35i3.6547. Epub 2018 Apr 28.
Some data suggest that anti-inflammatory macrolides may be effective to treat organizing pneumonia (OP) and prevent relapses, but no formal comparison with prednisone alone is available. To explore this issue, we retrospectively compared the efficacy of a 12-week combined regimen of clarithromycin and prednisone with a 24-week prednisone alone regimen in OP. A standard 12-week regimen of combined clarithromycin and prednisone was designed for the treatment of cryptogenic or radiation-induced OP, aiming at reducing the cumulated prednisone dose and the relapse rate. Its use was left to the discretion of the treating physicians, members of the Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires. Data were compared to a historical control group treated with a standard 24-week prednisone alone regimen. 16 patients were treated with combined therapy and 21 with prednisone alone. Complete radiological remission was achieved in 63% of the combined therapy group and 81% of the prednisone alone group (p=0.38). Symptomatic relapses occurred in 81% of the combined therapy group, and 52% of the prednisone alone group (p=0.14). No side effect of clarithromycin was reported. In patients with cryptogenic or radiation-induced OP, a 12-week regimen of clarithromycin and prednisone showed no benefit on remission rate and relapse rate as compared to a 24-week prednisone only regimen. .
一些数据表明，抗炎大环内酯类药物可能对治疗机化性肺炎（OP）及预防复发有效，但尚无与单独使用泼尼松的正式对比研究。为探究此问题，我们回顾性比较了克拉霉素与泼尼松联合使用12周的方案和单独使用泼尼松24周的方案在OP治疗中的疗效。设计了标准的克拉霉素与泼尼松联合使用12周的方案用于治疗隐源性或放射性诱导的OP，旨在减少泼尼松的累积剂量及复发率。该方案的使用由治疗医师自行决定，这些医师均为肺罕见病研究小组的成员。将数据与采用单独使用泼尼松标准24周方案治疗的历史对照组进行比较。16例患者接受联合治疗，21例患者单独使用泼尼松治疗。联合治疗组63%的患者实现了完全影像学缓解，单独使用泼尼松组为81%（p = 0.38）。联合治疗组81%的患者出现症状性复发，单独使用泼尼松组为52%（p = 0.14）。未报告克拉霉素的副作用。在隐源性或放射性诱导的OP患者中，与仅使用泼尼松24周的方案相比，克拉霉素与泼尼松联合使用12周的方案在缓解率和复发率方面未显示出优势。
