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Chest. 2013 Jul;144(1):215-225. doi: 10.1378/chest.12-1763.

Phase 3 randomized study of the efficacy and safety of inhaled dry powder mannitol for the symptomatic treatment of non-cystic fibrosis bronchiectasis.

Author information

1
Department of Respiratory Medicine, Royal Brompton Hospital, London, England. Electronic address: D.Bilton@rbht.nhs.uk.
2
Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
3
Department of Medicine, University of Auckland, Auckland, New Zealand.
4
Department of Respiratory Medicine, The Royal North Shore Hospital, Sydney, NSW, Australia.
5
Department of Allergy Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.
6
Department of Radiology, Auckland District Health Board, Auckland, New Zealand.
7
Medical Department, Pharmaxis, Sydney, NSW, Australia.

Abstract

BACKGROUND:

Inhaled dry powder mannitol enhanced mucus clearance and improved quality of life over 2 weeks in non-cystic fibrosis bronchiectasis. This study's objective was to investigate the efficacy and safety of dry powder mannitol over 12 weeks.

METHODS:

Patients with bronchiectasis confirmed by high-resolution CT (HRCT) scan, aged 15 to 80 years, with FEV1≥50% predicted and ≥1 L participated in a randomized, placebo-controlled, double-blind study. Patients with a negative mannitol provocation test were randomized to inhale 320 mg mannitol (n=231) or placebo (n=112) bid for 12 weeks. To further assess safety, the same mannitol dose/frequency was administered to a patient subset in an open-label extension over 52 weeks. Primary end points were changes from baseline at 12 weeks in 24-h sputum weight and St. George's Respiratory Questionnaire (SGRQ) score.

RESULTS:

There was a significant difference of 4.3 g in terms of change in sputum weight over 12 weeks (95% CI, 1.64-7.00; P=.002) between mannitol and placebo; however, this was largely driven by a decrease in sputum weight in the placebo group. This was associated, in turn, with more antibiotic use in the placebo group (50 of 112 [45%]) than in the inhaled mannitol group (85 of 231 [37%]). There was no statistical difference between the groups (P=.304) in total SGRQ score (mannitol, -3.4 points [95% CI, -4.81 to -1.94] vs placebo, -2.1 points [95% CI, -4.12 to -0.09]). In a subgroup study (n=82), patients receiving mannitol showed less small airway mucus plugging on HRCT scan at 12 weeks compared with patients receiving placebo (P=.048). Compliance rates were high, and mannitol was well tolerated with adverse events similar to those of placebo.

CONCLUSION:

Because the difference in sputum weights appears to be associated with increased antibiotic use in the placebo group, a larger controlled study is now required to investigate the long-term mannitol effect on pulmonary exacerbations and antibiotic use.

TRIAL REGISTRY:

ClinicalTrials.gov; No.: NCT0027753; URL: www.clinicaltrials.gov.

PMID:
23429964
DOI:
10.1378/chest.12-1763
[Indexed for MEDLINE]

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