Effects of azithromycin therapy on bronchiolitis obliterans syndrome after lung transplant: a meta-analysis

Objectives: Azithromycin has been used for the treatment of patients with bronchiolitis obliterans (BOS) syndrome after lung transplant and it has been shown to be effective on improving lung function. The overall effect of azithromycin on the absolute values of FEV1 has not been compared between reported studies. We studied the effects of azithromycin on lung function in patients with post-lung transplant BOS syndrome. Methods: A metaanalysis was performed using studies identified following an extensive database search. Studies were published without language limitation and explicitly reported lung function in FEV1 or hazard ratios. Results: A total of 10 studies were eligible for the analysis. Five hundred and sixty-one patients were evaluated after treatment with or without azithromycin for the patients with BOS. The mean percentage increase in FEV1 (%) was 10.97 (CI 5-16.94, P < 0.001) and the mean absolute values of FEV1 (L) increase was 0.31 (CI 0.26-0.37, P < 0.001) for a mean follow-up period of seven months. The pooled hazard ratio was 0.96 (CI 0.95-0.98, P < 0.001) for a mean follow-up period of 3.1 year. Conclusions: This study demonstrated a significant improvement in lung function in patients with BOS syndrome after lung transplant for a mean follow-up period of seven months and a trend toward decreased mortality from BOS syndrome on a long-term azithromycin therapy compared with these who were not.