What is the significance of the Bronchiectasis (bronchiectasis) Aspen trial?

From the Guidelines

The ASPEN trial demonstrated that azithromycin is effective in preventing exacerbations in patients with bronchiectasis, and its use is supported by recent guidelines 1.

Recommendation

Consider prescribing azithromycin 500 mg three times per week for 12-18 months in adults with bronchiectasis who have frequent exacerbations (3 or more per year), as this regimen has been shown to reduce exacerbation frequency and improve quality of life 1.

Specific Regimen

• Azithromycin 500 mg orally three times per week (e.g., Monday, Wednesday, Friday)
• Duration: 12-18 months
• Monitor for side effects, particularly hearing loss and cardiac arrhythmias

Additional Considerations

• Perform baseline ECG to check QT interval before starting treatment
• Assess for nontuberculous mycobacterial infection before initiating therapy
• Use with caution in patients with pre-existing liver disease

Justification

Azithromycin has both antimicrobial and anti-inflammatory properties, which help reduce airway inflammation, improve mucus clearance, and prevent bacterial colonization in bronchiectasis patients 1. The long-term, low-dose regimen helps maintain these benefits while minimizing side effects and antibiotic resistance. The European Respiratory Society guidelines suggest long-term treatment with macrolides, such as azithromycin, for adults with bronchiectasis and chronic P. aeruginosa infection, or for those with frequent exacerbations despite inhaled antibiotic treatment 1.

From the Research

Significance of the Bronchiectasis Aspen Trial

The Bronchiectasis Aspen trial is a significant study in the field of bronchiectasis research. The trial aims to evaluate the impact of brensocatib, an investigational oral reversible inhibitor of dipeptidyl peptidase-1, on exacerbation rate in adults with bronchiectasis 2.

Key Features of the Trial

• The trial is a global study enrolling patients with a clinical history consistent with bronchiectasis, diagnosis confirmed radiologically, and ≥2 exacerbations in the prior 12 months 2.
• The study evaluates the impact of two brensocatib doses (10 mg and 25 mg) on exacerbation rate over a 52-week treatment period versus placebo 2.
• Comprehensive clinical data, including demographics, disease severity, lung function, Pseudomonas aeruginosa status, and quality of life, were collected at baseline 2.

Importance of the Trial

• The trial addresses the need for new treatments for bronchiectasis, as highlighted by the European Respiratory Society guidelines for the management of adult bronchiectasis 3.
• The study's focus on brensocatib, a novel therapeutic agent, offers potential for improved treatment options for patients with bronchiectasis 2.
• The trial's findings may contribute to a better understanding of the disease and its treatment, ultimately leading to improved patient outcomes 2, 3.

Context of Bronchiectasis Research

• Bronchiectasis is a common condition that is likely to be underestimated, and its significance is increasingly recognized 4, 5, 3.
• Current treatments for bronchiectasis are largely based on extrapolation from other chronic lung diseases, and there is a need for more effective and targeted therapies 4, 5, 3.
• The use of macrolide antibiotics, such as azithromycin, has shown promise in reducing infectious exacerbations in patients with non-cystic fibrosis bronchiectasis 6.