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Long-term efficacy and safety of aerosolized tobramycin 300 mg/4 ml in cystic fibrosis.
Pediatr Pulmonol. 2014 Nov; 49(11):1076-89.PP

Abstract

INTRODUCTION

Aerosolized tobramycin is a standard of care for chronic Pseudomonas aeruginosa (Pa) infection in patients with cystic fibrosis (CF).

OBJECTIVES

The long-term safety and efficacy of intermittent (28-day "on"/"off" cycles) inhaled tobramycin nebulization solution 300 mg/4 ml (TNS4, Bramitob(®)/Bethkis(®)) was assessed over 56 weeks in CF patients aged ≥6 years having baseline 1 sec forced expiratory volume (FEV(1)) 40-80% predicted.

METHODS

Patients were initially randomized in an 8-week open-label trial (core phase) to compare TNS4 (N = 159) and tobramycin 300 mg/5 ml (TNS5, TOBI(®)) (N = 165). A subset of patients continued in a 48-week, single-arm extension receiving TNS4 only. The primary endpoint of the core phase was to demonstrate the non-inferiority of TNS4 compared to TNS5 in terms of absolute change from baseline to week 4 in FEV(1) % predicted. The assessment of long-term safety was the primary purpose of the extension phase. Throughout all phases of the study, microbiological assessments, adverse events, and audiometry findings were also evaluated.

RESULTS

In the core phase (N = 321), FEV(1) (% predicted) increased from baseline (absolute change) following a single on-treatment cycle for both TNS4 (7.0%) and TNS5 (7.5%) and the non-inferiority between treatments was met [difference between treatments of -0.5 (95% CI: -2.6; 1.6)]. These improvements were maintained throughout the extension phase (N = 209), ranging throughout the study between 5.1% (95% CI: 3.2; 6.9) and 8.1% (95% CI: 6.8; 9.4) compared to baseline. Pa sputum count reductions ranged between 0.6 (95% CI: 0.2; 0.9) to 2.3 (95% CI: 2.0; 2.6) log10 CFU/g throughout the 56 weeks. No remarkable safety issues were identified throughout both study phases, with similar percentages of patients reporting adverse events in the two treatment groups during the 8-week core phase [TNS4 (31.4%); TNS5 (28.0%)].

CONCLUSIONS

Overall, TNS4 demonstrated short-term clinical benefits similar to TNS5 which were maintained during the long-term use of TNS4 and was also associated with a favorable tolerability profile.

Authors+Show Affiliations

Instytut Gruźlicy i Chorób Pluc, Oddzial Terenowy im. Jana i Ireny Rudników w Rabce-Zdrój, Klinika Pneumonologii i Mukowiscydozy, Rabka-Zdrój, Poland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24464974

Citation

Mazurek, Henryk, et al. "Long-term Efficacy and Safety of Aerosolized Tobramycin 300 Mg/4 Ml in Cystic Fibrosis." Pediatric Pulmonology, vol. 49, no. 11, 2014, pp. 1076-89.
Mazurek H, Chiron R, Kucerova T, et al. Long-term efficacy and safety of aerosolized tobramycin 300 mg/4 ml in cystic fibrosis. Pediatr Pulmonol. 2014;49(11):1076-89.
Mazurek, H., Chiron, R., Kucerova, T., Geidel, C., Bolbas, K., Chuchalin, A., Blanco-Aparicio, M., Santoro, D., Varoli, G., Zibellini, M., Cicirello, H. G., & Antipkin, Y. G. (2014). Long-term efficacy and safety of aerosolized tobramycin 300 mg/4 ml in cystic fibrosis. Pediatric Pulmonology, 49(11), 1076-89. https://doi.org/10.1002/ppul.22989
Mazurek H, et al. Long-term Efficacy and Safety of Aerosolized Tobramycin 300 Mg/4 Ml in Cystic Fibrosis. Pediatr Pulmonol. 2014;49(11):1076-89. PubMed PMID: 24464974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term efficacy and safety of aerosolized tobramycin 300 mg/4 ml in cystic fibrosis. AU - Mazurek,Henryk, AU - Chiron,Raphaël, AU - Kucerova,Tereza, AU - Geidel,Christian, AU - Bolbas,Katalin, AU - Chuchalin,Alexander, AU - Blanco-Aparicio,Marina, AU - Santoro,Debora, AU - Varoli,Guido, AU - Zibellini,Marco, AU - Cicirello,Helen G, AU - Antipkin,Yuriy G, Y1 - 2014/01/24/ PY - 2012/12/21/received PY - 2013/12/02/accepted PY - 2014/1/28/entrez PY - 2014/1/28/pubmed PY - 2016/4/1/medline KW - FEV1 KW - Pseudomonas aeruginosa KW - cystic fibrosis KW - long-term KW - nebulization KW - tobramycin susceptibility SP - 1076 EP - 89 JF - Pediatric pulmonology JO - Pediatr Pulmonol VL - 49 IS - 11 N2 - INTRODUCTION: Aerosolized tobramycin is a standard of care for chronic Pseudomonas aeruginosa (Pa) infection in patients with cystic fibrosis (CF). OBJECTIVES: The long-term safety and efficacy of intermittent (28-day "on"/"off" cycles) inhaled tobramycin nebulization solution 300 mg/4 ml (TNS4, Bramitob(®)/Bethkis(®)) was assessed over 56 weeks in CF patients aged ≥6 years having baseline 1 sec forced expiratory volume (FEV(1)) 40-80% predicted. METHODS: Patients were initially randomized in an 8-week open-label trial (core phase) to compare TNS4 (N = 159) and tobramycin 300 mg/5 ml (TNS5, TOBI(®)) (N = 165). A subset of patients continued in a 48-week, single-arm extension receiving TNS4 only. The primary endpoint of the core phase was to demonstrate the non-inferiority of TNS4 compared to TNS5 in terms of absolute change from baseline to week 4 in FEV(1) % predicted. The assessment of long-term safety was the primary purpose of the extension phase. Throughout all phases of the study, microbiological assessments, adverse events, and audiometry findings were also evaluated. RESULTS: In the core phase (N = 321), FEV(1) (% predicted) increased from baseline (absolute change) following a single on-treatment cycle for both TNS4 (7.0%) and TNS5 (7.5%) and the non-inferiority between treatments was met [difference between treatments of -0.5 (95% CI: -2.6; 1.6)]. These improvements were maintained throughout the extension phase (N = 209), ranging throughout the study between 5.1% (95% CI: 3.2; 6.9) and 8.1% (95% CI: 6.8; 9.4) compared to baseline. Pa sputum count reductions ranged between 0.6 (95% CI: 0.2; 0.9) to 2.3 (95% CI: 2.0; 2.6) log10 CFU/g throughout the 56 weeks. No remarkable safety issues were identified throughout both study phases, with similar percentages of patients reporting adverse events in the two treatment groups during the 8-week core phase [TNS4 (31.4%); TNS5 (28.0%)]. CONCLUSIONS: Overall, TNS4 demonstrated short-term clinical benefits similar to TNS5 which were maintained during the long-term use of TNS4 and was also associated with a favorable tolerability profile. SN - 1099-0496 UR - https://www.unboundmedicine.com/medline/citation/24464974/Long_term_efficacy_and_safety_of_aerosolized_tobramycin_300_mg/4_ml_in_cystic_fibrosis_ L2 - https://doi.org/10.1002/ppul.22989 DB - PRIME DP - Unbound Medicine ER -