Tobramycin inhalation may decrease flares of non-cystic fibrosis bronchiectasis: Study

Non-cystic fibrosis bronchielctasis patients when assigned tobramycin inhalation solution once daily had a nonsignificant decrease in the number of exacerbations compared with a placebo, according to recent research.

Bronchiectasis is usually divided by that caused by cystic fibrosis (CF) and non-cystic fibrosis, however, previous studies revealed that in patients with stable non-CF bronchiectasis, 13 to 31 percent develop infections with Pseudomonas aeruginosa.

There is currently less experience with inhaled tobramycin in non-cystic fibrosis bronchiectasis than in cystic fibrosis (CF) but intravenous formulation and solution for inhalation (TSI) have been studied in non-CF bronchiectasis patients with chronic P. aeruginosa bronchial infection. In non-cystic fibrosis bronchiectasis, studies with inhaled antibiotics are limited

"Tobramycin inhalation solution with other inhaled antibiotics are part of the standard care in cystic fibrosis and especially in patients with pseudomonas aeruginosa colonization," Lotte C. Terpstra, Ph.D., of the department of pulmonology at Alkmaar Medical Center in the Netherlands, said during a presentation at the virtual European Respiratory Society International Congress.

Researchers conducted a randomized, double-blind, placebo-controlled, multicenter trial to investigate the efficacy and safety of inhaled tobramycin solution (Pfizer) in 58 patients with confirmed non-cystic fibrosis bronchiectasis and at least two exacerbations in the past year and positive sputum culture. Patients were randomly assigned to tobramycin inhalation solution maintenance treatment (n = 26) or placebo (n = 26) for 1 year.

The authors were aiming to achieve a 50% reduction in the number of exacerbations on maintenance tobramycin compared with the placebo. Also, the secondary endpoints were time to first exacerbation, lung function change, quality of life, sputum density and safety.

The following findings were highlighted-

3. A nonsignificant decrease in the number of bronchiectases exacerbations of 3.81 to 1.58 in patients treated with tobramycin compared with a decrease of 3.9 to 2.2 exacerbations for those treated with placebo
4. A 26% risk reduction for tobramycin inhalation solution.

As a result, the authors concluded that "Although the primary endpoint was not significantly reached, this study showed that tobramycin inhalation solution once daily is a treatment option for bronchiectasis patients with frequent exacerbations infected by different pathogens."