Trial Outcomes & Findings for Azithromycin to Prevent Wheezing Following Severe RSV Bronchiolitis-II (NCT NCT02911935)

NCT ID: NCT02911935

Last Updated: 2022-06-07

Results Overview

Episodes of wheezing were captured at each of the study telephone interviews and clinic visits using the question, "Has your child's chest sounded wheezy or whistling (with and without a cold)?". A new wheezing episode was defined if at least 7 days without wheezing had been reported since the previous episode.

Recruitment status

COMPLETED

Study phase

PHASE2/PHASE3

Target enrollment

200 participants

Primary outcome timeframe

Follow up duration of 18-48 months

Results posted on

2022-06-07

Participant Flow

Participant milestones

Participant milestones
Measure
Azithromycin
Participants received Azithromycin 10 mg/kg/d orally for 7 days and 5 mg/kg/d orally for additional 7 days
Placebo
Participants received Azithromycin placebo orally daily for 14 days
Overall Study
STARTED
101
99
Overall Study
COMPLETED
96
92
Overall Study
NOT COMPLETED
5
7

Reasons for withdrawal

Reasons for withdrawal
Measure
Azithromycin
Participants received Azithromycin 10 mg/kg/d orally for 7 days and 5 mg/kg/d orally for additional 7 days
Placebo
Participants received Azithromycin placebo orally daily for 14 days
Overall Study
Lost to Follow-up
5
7

Baseline Characteristics

One participant in Placebo arm refused to provide race/ethnicity information

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Azithromycin
n=101 Participants
Participants orally received Azithromycin 10 mg/kg/d for 7 days and 5 mg/kg/d for additional 7 days
Placebo
n=99 Participants
Participants orally received Azithromycin placebo daily for 14 days
Total
n=200 Participants
Total of all reporting groups
Age, Continuous
3.9 months
n=101 Participants
2.8 months
n=99 Participants
3.3 months
n=200 Participants
Sex: Female, Male
Female
47 Participants
n=101 Participants
44 Participants
n=99 Participants
91 Participants
n=200 Participants
Sex: Female, Male
Male
54 Participants
n=101 Participants
55 Participants
n=99 Participants
109 Participants
n=200 Participants
Race/Ethnicity, Customized
Race and ethnicity · African American
19 Participants
n=101 Participants • One participant in Placebo arm refused to provide race/ethnicity information
21 Participants
n=98 Participants • One participant in Placebo arm refused to provide race/ethnicity information
40 Participants
n=199 Participants • One participant in Placebo arm refused to provide race/ethnicity information
Race/Ethnicity, Customized
Race and ethnicity · Caucasian
72 Participants
n=101 Participants • One participant in Placebo arm refused to provide race/ethnicity information
72 Participants
n=98 Participants • One participant in Placebo arm refused to provide race/ethnicity information
144 Participants
n=199 Participants • One participant in Placebo arm refused to provide race/ethnicity information
Race/Ethnicity, Customized
Race and ethnicity · More than one race
10 Participants
n=101 Participants • One participant in Placebo arm refused to provide race/ethnicity information
5 Participants
n=98 Participants • One participant in Placebo arm refused to provide race/ethnicity information
15 Participants
n=199 Participants • One participant in Placebo arm refused to provide race/ethnicity information
Region of Enrollment
United States
101 Participants
n=101 Participants
99 Participants
n=99 Participants
200 Participants
n=200 Participants
Birth weight
3.3 kg
STANDARD_DEVIATION 0.5 • n=101 Participants
3.4 kg
STANDARD_DEVIATION 0.5 • n=99 Participants
3.3 kg
STANDARD_DEVIATION 0.5 • n=200 Participants
Birth by cesarean section
29 Participants
n=101 Participants
28 Participants
n=99 Participants
57 Participants
n=200 Participants
Gestational age at birth
38.9 weeks
STANDARD_DEVIATION 1.2 • n=101 Participants
38.8 weeks
STANDARD_DEVIATION 1.2 • n=99 Participants
38.8 weeks
STANDARD_DEVIATION 1.2 • n=200 Participants
Maternal smoking during pregnancy
19 Participants
n=101 Participants
13 Participants
n=99 Participants
32 Participants
n=200 Participants
History of breast feeding
75 Participants
n=101 Participants
80 Participants
n=99 Participants
155 Participants
n=200 Participants
History of eczema
16 Participants
n=101 Participants
13 Participants
n=99 Participants
29 Participants
n=200 Participants
Food allergy diagnosis
3 Participants
n=101 Participants
5 Participants
n=99 Participants
8 Participants
n=200 Participants
Parental history of asthma
33 Participants
n=101 Participants
39 Participants
n=99 Participants
72 Participants
n=200 Participants
Parental history of other atopic diseases
60 Participants
n=101 Participants
69 Participants
n=99 Participants
129 Participants
n=200 Participants
Pet exposure
59 Participants
n=101 Participants
71 Participants
n=99 Participants
130 Participants
n=200 Participants
Tobacco smoke exposure
40 Participants
n=101 Participants
26 Participants
n=99 Participants
66 Participants
n=200 Participants
Duration of hospital stay
51 hours
n=101 Participants • Two patients with missing values were excluded from the analysis population.
56 hours
n=97 Participants • Two patients with missing values were excluded from the analysis population.
52 hours
n=198 Participants • Two patients with missing values were excluded from the analysis population.
Duration of oxygen requirement, if required
46 hours
n=57 Participants • The analysis population only included infants were supplemented with oxygen if they had oxygen saturation of less than 90% on room air.
48 hours
n=57 Participants • The analysis population only included infants were supplemented with oxygen if they had oxygen saturation of less than 90% on room air.
47 hours
n=114 Participants • The analysis population only included infants were supplemented with oxygen if they had oxygen saturation of less than 90% on room air.
Lowest oxygen saturation on room air
90.6 percentage of oxygen saturation
STANDARD_DEVIATION 4.4 • n=101 Participants • Three patients with missing values were excluded from the analysis population.
90.7 percentage of oxygen saturation
STANDARD_DEVIATION 5.2 • n=96 Participants • Three patients with missing values were excluded from the analysis population.
90.7 percentage of oxygen saturation
STANDARD_DEVIATION 4.8 • n=197 Participants • Three patients with missing values were excluded from the analysis population.
Need for BiPAP ventilation
8 Participants
n=101 Participants • Two patients with missing values were excluded from the analysis population.
5 Participants
n=97 Participants • Two patients with missing values were excluded from the analysis population.
13 Participants
n=198 Participants • Two patients with missing values were excluded from the analysis population.
Bronchiolitis severity score
5.3 Scores on a scale
STANDARD_DEVIATION 1.8 • n=101 Participants
5.2 Scores on a scale
STANDARD_DEVIATION 1.8 • n=99 Participants
5.2 Scores on a scale
STANDARD_DEVIATION 1.8 • n=200 Participants
Other nonstudy antibiotic (nonmacrolide) use
30 Participants
n=101 Participants
28 Participants
n=99 Participants
58 Participants
n=200 Participants

PRIMARY outcome

Timeframe: Follow up duration of 18-48 months

Population: A total of 188 participants (96 in the azithromycin group and 92 in the placebo group) had at least one follow-up visit were included in the final primary outcome analysis.

Episodes of wheezing were captured at each of the study telephone interviews and clinic visits using the question, "Has your child's chest sounded wheezy or whistling (with and without a cold)?". A new wheezing episode was defined if at least 7 days without wheezing had been reported since the previous episode.

Outcome measures

Outcome measures
Measure
Azithromycin
n=96 Participants
Participants orally received Azithromycin 10 mg/kg/d for 7 days and 5 mg/kg/d for additional 7 days
Placebo
n=92 Participants
Participants orally received Azithromycin placebo daily for 14 days
Number of Participants Who Experienced the Occurrence of a Third Episode of Post-RSV Wheezing (Recurrent Wheeze)
45 Participants
33 Participants

SECONDARY outcome

Timeframe: Follow up duration of 18-48 months

Population: A total of 188 participants (96 in the azithromycin group and 92 in the placebo group) had at least one follow-up visit were included in the analysis.

Physician asthma diagnosis were captured at each of the study telephone interviews and clinic visits using the question, "Has the doctor told you that your child has asthma?".

Outcome measures

Outcome measures
Measure
Azithromycin
n=96 Participants
Participants orally received Azithromycin 10 mg/kg/d for 7 days and 5 mg/kg/d for additional 7 days
Placebo
n=92 Participants
Participants orally received Azithromycin placebo daily for 14 days
Number of Participants Who Had Physician Asthma Diagnosis
15 Participants
8 Participants

SECONDARY outcome

Timeframe: Follow up duration of 18-48 months

Population: A total of 188 participants (96 in the azithromycin group and 92 in the placebo group) had at least one follow-up visit were included in this analysis.

The number of days with respiratory symptoms were captured during clinic visits and by telephone interviews every other month using two questions, "Does your child have coughing, wheezing, shortness of breath or chest tightness during the daytime?", "If yes, estimate the number of days". We used a negative binomial regression analysis with an offset term to adjust for duration of follow-up to get the annualized rate estimate.

Outcome measures

Outcome measures
Measure
Azithromycin
n=96 Participants
Participants orally received Azithromycin 10 mg/kg/d for 7 days and 5 mg/kg/d for additional 7 days
Placebo
n=92 Participants
Participants orally received Azithromycin placebo daily for 14 days
Annualized Number of Days With Respiratory Symptoms (Wheezing, Cough, or Shortness of Breath)
26.2 days per year
Interval 21.0 to 32.8
22.2 days per year
Interval 17.7 to 27.9

SECONDARY outcome

Timeframe: Follow up duration of 18-48 months

Population: A total of 188 participants (96 in the azithromycin group and 92 in the placebo group) had at least one follow-up visit were included in this analysis.

The number of days with albuterol use were captured during clinic visits and by telephone interviews every other month using two questions, "Has your child taken Albuterol (also known as Ventolin, Pro-air, Proventil)?" and "please estimate # of days your child had albuterol treatments since the last visit". We used a negative binomial regression analysis with an offset term to adjust for duration of follow-up to get the annualized rate estimate.

Outcome measures

Outcome measures
Measure
Azithromycin
n=96 Participants
Participants orally received Azithromycin 10 mg/kg/d for 7 days and 5 mg/kg/d for additional 7 days
Placebo
n=92 Participants
Participants orally received Azithromycin placebo daily for 14 days
Annualized Number of Days With Albuterol Use
4 days per year
Interval 2.4 to 6.6
3.3 days per year
Interval 2.0 to 5.4

SECONDARY outcome

Timeframe: Follow up duration of 18-48 months

Population: A total of 188 participants (96 in the azithromycin group and 92 in the placebo group) had at least one follow-up visit were included in this analysis.

The number of oral corticosteroid courses were captured during clinic visits and by telephone interviews every other month using two questions, "Has your child taken Oral steroids (Prednisone, Prednisolone, Orapred, Dexamethasone)?" and "how many separate courses of steroids has your child had since the last visit?". We used a negative binomial regression analysis with an offset term to adjust for duration of follow-up to get the annualized rate estimate.

Outcome measures

Outcome measures
Measure
Azithromycin
n=96 Participants
Participants orally received Azithromycin 10 mg/kg/d for 7 days and 5 mg/kg/d for additional 7 days
Placebo
n=92 Participants
Participants orally received Azithromycin placebo daily for 14 days
Annualized Number of Oral Corticosteroid Courses
0.23 courses per year
Interval 0.15 to 0.35
0.17 courses per year
Interval 0.1 to 0.27

SECONDARY outcome

Timeframe: Follow up duration of 18-48 months

Population: A total of 188 participants (96 in the azithromycin group and 92 in the placebo group) had at least one follow-up visit were included in this analysis.

The number of antibiotic courses were captured during clinic visits and by telephone interviews every other month using two questions, "Has your child taken any antibiotics?" and "How many separate prescriptions has your child taken of an antibiotic(s)?". We used a negative binomial regression analysis with an offset term to adjust for duration of follow-up to get the annualized rate estimate.

Outcome measures

Outcome measures
Measure
Azithromycin
n=96 Participants
Participants orally received Azithromycin 10 mg/kg/d for 7 days and 5 mg/kg/d for additional 7 days
Placebo
n=92 Participants
Participants orally received Azithromycin placebo daily for 14 days
Annualized Number of Antibiotic Courses
1.2 courses per year
Interval 0.95 to 1.4
1.3 courses per year
Interval 1.0 to 1.5

SECONDARY outcome

Timeframe: Follow up duration of 18-48 months

Serious Adverse Event were captured during clinic visits and by telephone interviews every other month using designed SAE form.

Outcome measures

Outcome measures
Measure
Azithromycin
n=101 Participants
Participants orally received Azithromycin 10 mg/kg/d for 7 days and 5 mg/kg/d for additional 7 days
Placebo
n=99 Participants
Participants orally received Azithromycin placebo daily for 14 days
Number of Participants Who Experienced Serious Adverse Events
15 Participants
16 Participants

Adverse Events

Azithromycin

Serious events: 15 serious events
Other events: 73 other events
Deaths: 0 deaths

Placebo

Serious events: 16 serious events
Other events: 72 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Azithromycin
n=101 participants at risk
Participants orally received azithromycin 10mg/kg/day for 7 days; then oral azithromycin 5mg/kg/day for 7 additional days
Placebo
n=99 participants at risk
Participants orally received placebo daily for 14 days.
Gastrointestinal disorders
Accidental drug ingestion
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Gastrointestinal disorders
Acute appendicitis
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Choking
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
General disorders
ED visit for gastroenteritis
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Infections and infestations
High Fever
0.00%
0/101 • Follow up duration of 18-48 months
2.0%
2/99 • Number of events 2 • Follow up duration of 18-48 months
Musculoskeletal and connective tissue disorders
Hospitalization for bone fracutre
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Hospitalization for respiratory distress
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Hospitalization for wheezing
4.0%
4/101 • Number of events 5 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 2 • Follow up duration of 18-48 months
Nervous system disorders
Hospitalized for observation and video EEG
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Infections and infestations
Preseptal Cellulitis
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Respiratory failure/distress
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
General disorders
Scheduled surgery for bilateral myringotomy with tube insertion and bilateral Adenotonsillectomy
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Transferred to PICU during respiratory infection
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
3.0%
3/99 • Number of events 3 • Follow up duration of 18-48 months
Musculoskeletal and connective tissue disorders
Hospitalization with hematoma
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Hospitalized after bronchoscopy
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
Infections and infestations
Hospitalized for a UTI and fever
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
General disorders
Hospitalized for dehydration
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Hospitalized for observation following bronchoscopy, BAL and EGD with biopsies
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
General disorders
Hospitalized for planned right open pyeloplasty and observation
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Hospitalized with respiratory infection
5.9%
6/101 • Number of events 6 • Follow up duration of 18-48 months
3.0%
3/99 • Number of events 4 • Follow up duration of 18-48 months
Gastrointestinal disorders
Hospitalized with bloody diarrhea
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Nervous system disorders
Hospitalized with questionable seizurelike activity
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Hospitalized with pneumonia
0.99%
1/101 • Number of events 2 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Hospitalized for asthma exacerbation
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 3 • Follow up duration of 18-48 months

Other adverse events

Other adverse events
Measure
Azithromycin
n=101 participants at risk
Participants orally received azithromycin 10mg/kg/day for 7 days; then oral azithromycin 5mg/kg/day for 7 additional days
Placebo
n=99 participants at risk
Participants orally received placebo daily for 14 days.
Gastrointestinal disorders
Abdominal pain
2.0%
2/101 • Number of events 2 • Follow up duration of 18-48 months
5.1%
5/99 • Number of events 5 • Follow up duration of 18-48 months
Blood and lymphatic system disorders
Abnormal Neutrophil Count
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Blood and lymphatic system disorders
Abnormal platelet count
4.0%
4/101 • Number of events 4 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Infections and infestations
Acute Otitis Media
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Gastrointestinal disorders
GERD
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Gastrointestinal disorders
Loose stool
3.0%
3/101 • Number of events 3 • Follow up duration of 18-48 months
2.0%
2/99 • Number of events 2 • Follow up duration of 18-48 months
Infections and infestations
Skin infection
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Wheezing
5.9%
6/101 • Number of events 6 • Follow up duration of 18-48 months
5.1%
5/99 • Number of events 5 • Follow up duration of 18-48 months
Eye disorders
Blocked tear duct
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
General disorders
Blood in urine
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
Gastrointestinal disorders
Constipation
0.00%
0/101 • Follow up duration of 18-48 months
3.0%
3/99 • Number of events 3 • Follow up duration of 18-48 months
Blood and lymphatic system disorders
Decreased Neutrophil count
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
Gastrointestinal disorders
Diarrhea
29.7%
30/101 • Number of events 31 • Follow up duration of 18-48 months
21.2%
21/99 • Number of events 21 • Follow up duration of 18-48 months
Infections and infestations
Ear infection
13.9%
14/101 • Number of events 14 • Follow up duration of 18-48 months
14.1%
14/99 • Number of events 16 • Follow up duration of 18-48 months
Infections and infestations
Fever
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Nervous system disorders
Fussy
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Infections and infestations
Pink eye
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
General disorders
Pneumonia
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Skin and subcutaneous tissue disorders
Rash
7.9%
8/101 • Number of events 9 • Follow up duration of 18-48 months
6.1%
6/99 • Number of events 7 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Severe obstructive sleep apnea
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Nervous system disorders
Sleep myoclonus
0.99%
1/101 • Number of events 1 • Follow up duration of 18-48 months
0.00%
0/99 • Follow up duration of 18-48 months
Infections and infestations
Strep infection
0.00%
0/101 • Follow up duration of 18-48 months
1.0%
1/99 • Number of events 1 • Follow up duration of 18-48 months
Respiratory, thoracic and mediastinal disorders
Upper respiratory infection
32.7%
33/101 • Number of events 33 • Follow up duration of 18-48 months
22.2%
22/99 • Number of events 23 • Follow up duration of 18-48 months
Gastrointestinal disorders
Vomiting
9.9%
10/101 • Number of events 10 • Follow up duration of 18-48 months
7.1%
7/99 • Number of events 7 • Follow up duration of 18-48 months

Additional Information

Dr. Avraham Beigelman

Washington University School of Medicine.

Phone: 314-454-2694

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place