108 Analysis of dry powder inhaler (DPI) antibiotics in an adult cystic fibrosis (CF) centre

Abstract

Objectives DPI antibiotics have been shown to be non-inferior when compared with nebulised antibiotics in research study conditions. Analysis of local anonymous questionnaires demonstrated patient preference for DPIs. We wanted to assess the effect of DPI antibiotics on clinical outcomes in our adult CF population by analysing real world data. Methods Retrospective analysis of inhaled antibiotic therapies (continuous or alternate month regimes) prescribed between June 2012 and January 2015 identified from our CF clinical database. Patients starting DPI were divided into 2 groups: Group A – those converting from nebulised to DPI antibiotics for at least 6 months, and Group B – not on nebulised antibiotics for at least 6 months due to previous intolerance. Best FEV1 and weight, and number of days of IV antibiotic treatment in the 6 month period before and after starting DPI were compared. Paired t test and Wilcoxon signed rank test were used for statistical analysis. Results 149 patients completed successful first dose DPI trials. 70 had complete data sets (49 in group A; 21 in group B). There was no significant difference in pre-DPI versus post-DPI FEV1 or weight in either group. There was a significant reduction in the number of IV days in group B (from median 14 days to 0 days, p = 0.032) but not group A after starting DPI. Conclusion This real world data is consistent with previous studies showing that DPI antibiotics are non-inferior compared to nebulised antibiotics, and demonstrates that the use of DPI antibiotics is associated with clinically useful reduction in need for IV antibiotic therapy. Studies over a longer follow up period are required.