Patients with
cystic fibrosis (CF) develop
pulmonary disease secondary to airway
infection and dysregulated
inflammation. Therapeutic innovations such as nebulized antimicrobial
therapy targeting specific pathogens have resulted in improvements in quality of life and life expectancy.
Aztreonam lysine for inhalation (AZLI)
solution was initially approved to improve respiratory symptoms in CF patients with Pseudomonas aeruginosa (PA) in 2010 by the Food and Drug Administration. Since then, research broadening labeling and clinical application has been developed. In this review, we analyze published and ongoing research regarding AZLI
therapy in CF. A search of the Cochrane Database of Systematic Reviews and the PubMed and ClinicalTrials.gov databases was conducted to identify publications about AZLI. Three pre-approval studies were identified and assessed. Two are Phase 3, placebo-controlled trials, assessing a variety of safety and efficacy endpoints, leading to FDA approval. The third is an open-label extension of the two previous trials. An additional seven post-approval, completed trials were identified and are included in this review. They represent a variety of study designs including safety and efficacy in patients with mild
lung disease and young patients, an active comparator trial vs inhaled
tobramycin, an eradication study, a study among patients with Burkholderia cepacia, and a study assessing continuous alternating
antibiotic therapy. Finally, five ongoing clinical trials are discussed. Overall, studies demonstrated that inhaled
aztreonam is a safe and effective antimicrobial treatment for the eradication of newly acquired P. aeruginosa and long-term suppressive
therapy of chronic endobronchial
infection among people with
cystic fibrosis.