Researchers recently found no differences in the number of antipseudomonal classes administered in primary or sensitivity analyses in patients with cystic fibrosis (CF) regarding lung function, symptom response, odds of retreatment, or future pulmonary exacerbation hazard, as published in the Journal of Cystic Fibrosis.

VanDevanter and colleagues conducted a retrospective analysis of the Standardized Treatment of Pulmonary Exacerbations 2 to study treatment responses in patients with pulmonary exacerbation and acute Pseudomonas aeruginosa infection.

Among the 751 participants of this study, 50 (6.7%) received 1 antipseudomonal class before the second visit, while 552 (73.5%) and 149 (19.8%) received 2 and 3 classes, respectively. The authors compared mean lung function and symptom changes between the 2 visits spaced 7 to 10 days.

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For decades, treatment guidelines regarding patients with CF and pulmonary exacerbation suggest that P. aeruginosa airway infection should receive 2 antipseudomonal agents. Regardless, these results provided no evidence of differing pulmonary exacerbation treatment responses among those with P. aeruginosa airway infection as a function of the number of antipseudomonal classes administered. Moreover, this study could not identify additional benefits when choosing multiple classes.

“In fact, the handful of prospective randomized trials that have been conducted, most of which were relatively small, were unable to identify an immediate clinical benefit with respect to either lung function or symptom score associated with combination antipseudomonal [pulmonary exacerbation] treatment,” the authors wrote.

Given the potential increased cost, complexity, and risk of harm associated with treating CF pulmonary exacerbation with more than 1 antipseudomonal class, objective evidence of a clear benefit to justify this practice is primordial, which might only be achieved by a randomized prospective trial.

Chronic pain in the airways of patients with CF has been associated with accelerated lung disease progression and increased mortality risk. Accordingly, P. aeruginosa garners particular attention when people with CF experience a pulmonary exacerbation, acute periods of increased respiratory signs and symptoms often accompanied by a drop in lung function.

Reference

VanDevanter D, West N, Sanders D, et al. Antipseudomonal treatment decisions during CF exacerbation management. J Cyst Fibros. Published April 21, 2022. doi:10.1016/j.jcf.2022.04.006