A 12-week combination of clarithromycin and prednisone for the treatment of cryptogenic and radiation-induced organising pneumonia

Abstract

Introduction: Corticosteroids are a very effective treatment of cryptogenic organising pneumonia (OP), but the optimal regimen is unknown, side effects occur, and relapses are common. Small series suggested that macrolides are of interest in both treating OP and preventing relapses. Aims: To determine the efficacy of a 12-wk combined treatment (clarithromycin + prednisone) compared to a standard 24-wk prednisone regimen in OP. Methods: In a retrospective study, we included all patients with cryptogenic or radiation-induced OP who were treated with a pre-established 12-wk regimen consisting of clarithromycin (1000 mg/d for 10 days, then 500 mg/d until wk 8, then 250 mg/d until wk 12) and prednisone (0.75 mg/kg/d for 2 wk, 0.5 mg/kg/d for 2 wk, 20 mg/d for 2 wk, 10 mg/d for 3 wk and 5 mg/d for 3 wk, CLA+PRED group). These cases were compared to a historical group of cryptogenic OP which received a 24-wk prednisone only regimen (PRED only group, Lazor R et al, Am J Respir Crit Care Med 2000; 162:571-7). The outcomes were the percentage of complete cure and relapses. Results: 20 patients (age 63±13 yr) with cryptogenic (n=13) or radiation-induced (n=7) OP treated with CLA+PRED were compared to 14 patients with cryptogenic OP treated with PRED only. Complete cure occurred in 55% of the CLA+PRED group and 93% in the PRED only group. Relapses occurred in 85% in the CLA+PRED group, and in 57% in the PRED only group. No patient died or had respiratory failure. Conclusions: A 12-wk course of clarithromycin + prednisone led to lower complete cure rates and more frequent relapses in patients with cryptogenic or radiation-induced OP, compared to a 24-wk prednisone only regimen.