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Abbreviation used
TELICAST: Telithromycin, Chlamydophila, and Asthma
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FIG 1. Telithromycin treatment increases the magnitude of improvements in symptoms (A) and lung function
(B), as well as hastening recovery from acute exacerbations of asthma in adult asthmatic subjects (C).17
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exacerbations of asthma in adults.17 This study of 278 patients with moderate-to-severe asthma exacerbations reported
significantly greater improvements in both symptoms and
lung function in patients receiving active treatment compared with those receiving placebo. Improvement in
asthma symptoms from exacerbation to the end of treatment in the telithromycin-treated patients was 51% versus
29% in placebo-treated patients (Fig 1, A; mean difference, 22% (95% CI, 36.6% to 7.9%]; P 5 .003). Several
markers of lung function also showed significantly greater
improvement, with FEV1 improving by 0.63 L in telithromycin-treated patients versus 0.34 L in placebo-treated
patients (Fig 1, B; mean difference between treatments,
0.29 L (95% CI, 0.12-0.46 L]; P 5 .001). Time to 50%
improvement in symptoms was 8 days in placebo-treated
patients compared with only 5 days in telithromycin-treated
patients (Fig 1, C; P 5 .03).
The observed treatment effects appear to be of clinical
importance and were achieved on top of the usual care
given for asthma exacerbations (including a standardized
regimen of oral prednisone if considered necessary). These
findings need confirmation with further studies but, if
confirmed, suggest that rewriting of treatment guidelines might be necessary.
A further aim of the TELICAST study was to shed light
on possible mechanisms of action of any observed treatment effect. To this end, intensive diagnostic testing was
carried out, including culture and several different PCR
assays for C pneumoniae and M pneumoniae in sputum
samples, as well as intensive serology for both organisms.
Sixty-one percent of patients met at least one criterion
for C pneumoniae positivity, M pneumoniae positivity
(mostly C pneumoniae), or both, although almost all positive criteria were serologic. However, there was no clear
indication of greater treatment effect in those with evidence of infection compared with that seen in those without. Diagnostic testing for these organisms is still clearly
not optimal and differs from one laboratory to another.
Further work improving diagnostic methodologies and
identifying patient groups most likely to benefit from these
new approaches to treatment is clearly needed.