Anti-inflammatory Effects of Macrolide Treatment in Influenza Lower Respiratory Tract Infections

NCT ID: NCT01779570

Last Updated: 2016-07-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

68 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-02-28

Study Completion Date

2016-04-30

Brief Summary

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Influenza lower respiratory tract infection (LRTI) is a major cause of morbidity and mortality worldwide. While viral replication can be suppressed by antiviral treatment, excessive inflammatory responses, which are increasingly recognized to contribute to severe influenza complications, remain unopposed. Macrolides have been used widely to treat community-acquired pneumonia, and shown to exert anti-inflammatory effects in other respiratory diseases, providing clinical benefits. In this randomized, open-label, multicenter study, we aim to investigate the anti-inflammatory effects of macrolide treatment in influenza LRTI. Its impacts on the cytokine response, viral clearance, symptoms and disease resolution will be studied. Such results may lead to the development of new therapeutic approaches against severe influenza infection, and provide better insights into disease pathogenesis.

Detailed Description

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Objectives: (1) We aim to investigate the anti-inflammatory effects of macrolide treatment in patients with influenza LRTI and the impact on viral clearance. (2) To investigate the impact of macrolide treatment on influenza symptom and disease resolution.

Design: A randomized, open-label, multicenter study.

Settings: Acute medical facilities in 3 general public hospitals in Hong Kong.

Subjects, Sampling and Intervention: Adult (\>/=18 years) patients hospitalized for virologically confirmed influenza LRTI who fulfill the inclusion/exclusion criteria will be randomized to receive (1) azithromycin 500 mg p.o. for 5 days (in addition to antiviral, as part of usual care), or (2) no azithromycin (ie, antiviral alone, part of usual care) after informed consent. Serial blood samples will be collected for cytokine/inflammatory response assays. Serial nasopharyngeal swabs will be collected to assess for viral clearance. Symptoms, clinical progress, radiography and adverse events will be monitored.

Conditions

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Influenza Lower Respiratory Tract Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Macrolide treatment

Azithromycin 500 mg daily for 5 days

Group Type EXPERIMENTAL

Macrolide treatment

Intervention Type DRUG

No macrolide treatment

No azithromycin

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Macrolide treatment

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. established influenza A or B infection by virologic tests
2. age \>/=18 years
3. present within 4 days from illness onset
4. clinical evidence of LRTI and require hospital care
5. require antiviral (oseltamivir) treatment
6. able to provide written, informed consent.

Exclusion Criteria

1. patients on immunosuppressants
2. pregnant or lactating woman
3. known hepatic failure, end-stage renal failure, cardiac arrhythmia (e.g. prolonged corrected QT interval \>450 msec)
4. known contraindications to azithromycin (e.g. allergic reaction)
5. lack of consent for study.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Chinese University of Hong Kong

OTHER

Sponsor Role lead

Responsible Party

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Nelson Lee

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nelson LS Lee, MD

Role: PRINCIPAL_INVESTIGATOR

Chinese University of Hong Kong

Locations

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Prince of Wales Hospital

Hong Kong, , Hong Kong

Site Status

Princess Margaret Hospital

Hong Kong, , Hong Kong

Site Status

Countries

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Hong Kong

References

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Chan PK, Chan MC, Cheung JL, Lee N, Leung TF, Yeung AC, Wong MC, Ngai KL, Nelson EA, Hui DS. Influenza B lineage circulation and hospitalization rates in a subtropical city, Hong Kong, 2000-2010. Clin Infect Dis. 2013 Mar;56(5):677-84. doi: 10.1093/cid/cis885. Epub 2012 Oct 16.

Reference Type BACKGROUND
PMID: 23074315 (View on PubMed)

Chan PK, Lee N, Zaman M, Adisasmito W, Coker R, Hanshaoworakul W, Gasimov V, Oner AF, Dogan N, Tsang O, Phommasack B, Touch S, Bamgboye E, Swenson A, Toovey S, Dreyer NA. Determinants of antiviral effectiveness in influenza virus A subtype H5N1. J Infect Dis. 2012 Nov;206(9):1359-66. doi: 10.1093/infdis/jis509. Epub 2012 Aug 20.

Reference Type BACKGROUND
PMID: 22927451 (View on PubMed)

Lee N, Ison MG. Diagnosis, management and outcomes of adults hospitalized with influenza. Antivir Ther. 2012;17(1 Pt B):143-57. doi: 10.3851/IMP2059. Epub 2012 Feb 3.

Reference Type BACKGROUND
PMID: 22311561 (View on PubMed)

Lee N, Wong CK, Chan PK, Chan MC, Wong RY, Lun SW, Ngai KL, Lui GC, Wong BC, Lee SK, Choi KW, Hui DS. Cytokine response patterns in severe pandemic 2009 H1N1 and seasonal influenza among hospitalized adults. PLoS One. 2011;6(10):e26050. doi: 10.1371/journal.pone.0026050. Epub 2011 Oct 13.

Reference Type BACKGROUND
PMID: 22022504 (View on PubMed)

Lee N, Chan PK, Lui GC, Wong BC, Sin WW, Choi KW, Wong RY, Lee EL, Yeung AC, Ngai KL, Chan MC, Lai RW, Yu AW, Hui DS. Complications and outcomes of pandemic 2009 Influenza A (H1N1) virus infection in hospitalized adults: how do they differ from those in seasonal influenza? J Infect Dis. 2011 Jun 15;203(12):1739-47. doi: 10.1093/infdis/jir187.

Reference Type BACKGROUND
PMID: 21606532 (View on PubMed)

Lee N, Chan PK, Wong CK, Wong KT, Choi KW, Joynt GM, Lam P, Chan MC, Wong BC, Lui GC, Sin WW, Wong RY, Lam WY, Yeung AC, Leung TF, So HY, Yu AW, Sung JJ, Hui DS. Viral clearance and inflammatory response patterns in adults hospitalized for pandemic 2009 influenza A(H1N1) virus pneumonia. Antivir Ther. 2011;16(2):237-47. doi: 10.3851/IMP1722.

Reference Type BACKGROUND
PMID: 21447873 (View on PubMed)

Lee N, Choi KW, Chan PK, Hui DS, Lui GC, Wong BC, Wong RY, Sin WY, Hui WM, Ngai KL, Cockram CS, Lai RW, Sung JJ. Outcomes of adults hospitalised with severe influenza. Thorax. 2010 Jun;65(6):510-5. doi: 10.1136/thx.2009.130799.

Reference Type BACKGROUND
PMID: 20522848 (View on PubMed)

Hui DS, Lee N, Chan PK. Clinical management of pandemic 2009 influenza A(H1N1) infection. Chest. 2010 Apr;137(4):916-25. doi: 10.1378/chest.09-2344. Epub 2009 Dec 18.

Reference Type BACKGROUND
PMID: 20022969 (View on PubMed)

Lee N, Chan PK, Hui DS, Rainer TH, Wong E, Choi KW, Lui GC, Wong BC, Wong RY, Lam WY, Chu IM, Lai RW, Cockram CS, Sung JJ. Viral loads and duration of viral shedding in adult patients hospitalized with influenza. J Infect Dis. 2009 Aug 15;200(4):492-500. doi: 10.1086/600383.

Reference Type BACKGROUND
PMID: 19591575 (View on PubMed)

Lee N, Wong CK, Chan PK, Lun SW, Lui G, Wong B, Hui DS, Lam CW, Cockram CS, Choi KW, Yeung AC, Tang JW, Sung JJ. Hypercytokinemia and hyperactivation of phospho-p38 mitogen-activated protein kinase in severe human influenza A virus infection. Clin Infect Dis. 2007 Sep 15;45(6):723-31. doi: 10.1086/520981. Epub 2007 Aug 8.

Reference Type BACKGROUND
PMID: 17712756 (View on PubMed)

Lee N, Chan PK, Choi KW, Lui G, Wong B, Cockram CS, Hui DS, Lai R, Tang JW, Sung JJ. Factors associated with early hospital discharge of adult influenza patients. Antivir Ther. 2007;12(4):501-8.

Reference Type BACKGROUND
PMID: 17668558 (View on PubMed)

Lee N, Wong CK, Chan MCW, Yeung ESL, Tam WWS, Tsang OTY, Choi KW, Chan PKS, Kwok A, Lui GCY, Leung WS, Yung IMH, Wong RYK, Cheung CSK, Hui DSC. Anti-inflammatory effects of adjunctive macrolide treatment in adults hospitalized with influenza: A randomized controlled trial. Antiviral Res. 2017 Aug;144:48-56. doi: 10.1016/j.antiviral.2017.05.008. Epub 2017 May 20.

Reference Type DERIVED
PMID: 28535933 (View on PubMed)

Related Links

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http://www.mect.cuhk.edu.hk/specialties/infectiousdiseases.html

Division of Infectious Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong

Other Identifiers

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RGC CUHK468112

Identifier Type: -

Identifier Source: org_study_id

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