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@article{Wilson:2020:10.1001/jama.2020.22960,
author = {Wilson, AM and Clark, AB and Cahn, T and Chilvers, ER and Fraser, W and Hammond, M and Livermore, DM and Maher, TM and Parfrey, H and Swart, AM and Stirling, S and Thickett, DR and Whyte, M},
doi = {10.1001/jama.2020.22960},
journal = {JAMA: Journal of the American Medical Association},
pages = {2282--2291},
title = {Effect of co-trimoxazole (Trimethoprim-Sulfamethoxazole) vs placebo on death, lung transplant, or hospital admission in patients with moderate and severe idiopathic pulmonary fibrosis the EME-TIPAC randomized clinical trial},
url = {http://dx.doi.org/10.1001/jama.2020.22960},
volume = {324},
year = {2020}
}

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TY  - JOUR
AB  - Importance  Idiopathic pulmonary fibrosis (IPF) has a poor prognosis and limited treatment options. Patients with IPF have altered lung microbiota, with bacterial burden within the lungs associated with mortality; previous studies have suggested benefit with co-trimoxazole (trimethoprim-sulfamethoxazole).Objective  To determine the efficacy of co-trimoxazole in patients with moderate and severe IPF.Design, Setting, and Participants  Double-blind, placebo-controlled, parallel randomized trial of 342 patients with IPF, breathlessness (Medical Research Council dyspnea scale score >1), and impaired lung function (forced vital capacity ≤75% predicted) conducted in 39 UK specialist interstitial lung disease centers between April 2015 (first patient visit) and April 2019 (last patient follow-up).Interventions  Study participants were randomized to receive 960 mg of oral co-trimoxazole twice daily (n = 170) or matched placebo (n = 172) for between 12 and 42 months. All patients received 5 mg of folic acid orally once daily.Main Outcomes and Measures  The primary outcome was time to death (all causes), lung transplant, or first nonelective hospital admission. There were 15 secondary outcomes, including the individual components of the primary end point respiratory-related events, lung function (forced vital capacity and gas transfer), and patient-reported outcomes (Medical Research Council dyspnea scale, 5-level EuroQol 5-dimension questionnaire, cough severity, Leicester Cough Questionnaire, and King’s Brief Interstitial Lung Disease questionnaire scores).Results  Among 342 individuals who were randomized (mean age, 71.3 years; 46 [13%] women), 283 (83%) completed the trial. The median (interquartile range) duration of follow-up was 1.02 (0.35-1.73) years. Events per person-year of follow-up among participants randomized to the co-trimoxazole and placebo groups were 0.45 (84/186) and 0.38 (80/209), respectively, with a hazard ratio of
AU  - Wilson,AM
AU  - Clark,AB
AU  - Cahn,T
AU  - Chilvers,ER
AU  - Fraser,W
AU  - Hammond,M
AU  - Livermore,DM
AU  - Maher,TM
AU  - Parfrey,H
AU  - Swart,AM
AU  - Stirling,S
AU  - Thickett,DR
AU  - Whyte,M
DO  - 10.1001/jama.2020.22960
EP  - 2291
PY  - 2020///
SN  - 0098-7484
SP  - 2282
TI  - Effect of co-trimoxazole (Trimethoprim-Sulfamethoxazole) vs placebo on death, lung transplant, or hospital admission in patients with moderate and severe idiopathic pulmonary fibrosis the EME-TIPAC randomized clinical trial
T2  - JAMA: Journal of the American Medical Association
UR  - http://dx.doi.org/10.1001/jama.2020.22960
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000598023000019&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://jamanetwork.com/journals/jama/fullarticle/2773680
UR  - http://hdl.handle.net/10044/1/85375
VL  - 324
ER  -

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