Background

Nebulization of antimicrobial drugs such as tobramycin and colistin is a cornerstone in the treatment of patients with cystic fibrosis (CF) infected with Pseudomonas aeruginosa. However, nebulization has a high treatment burden. The Twincer^™ is a dry powder inhaler specifically developed for the inhalation of antibiotics such as colistin. The aim of this study was to compare patient outcomes and experience with colistin dry powder by the Twincer with nebulization of colistin or tobramycin in adult CF patients in a real-life setting.

Methods

This was a retrospective study from 01-01-2015 until 01-07-2018. Effectiveness was evaluated by comparing FEV₁ decline and exacerbation rate during a mean of 4.1 years of nebulization therapy prior to the initiation of the Twincer against the same values during a mean of 1.7 years of treatment with the Twincer.

Results

Twenty-one patients were evaluated, of whom twelve could be included in the effectiveness analysis, with a total of twenty patient years. Of all patients 71.4% preferred therapy with the Twincer over nebulization. Twincer use resulted in high treatment adherence with an average adherence rate of 92.5%. There was no significant difference in annual decline in FEV₁%pred prior to and after start changing from nebulization to the use of the Twincer powder inhaler (median decline -1.56 [-5.57–5.31] and 1.35 [-8.45–6.36]) respectively, p = 0.45 (linear mixed effect model)). No significant difference was found in the number of intravenous or combined total intravenous and oral antibiotic courses during Twincer therapy compared to when using nebulization (1.68 and 2.49 courses during Twincer therapy versus 1.51 and 2.94 courses during nebulization, p = 0.88 and p = 0.63).

Conclusion

Colistin dry powder inhalation with the Twincer is a more patient friendly alternative to nebulization, and we did not observe significant differences in the clinical outcome, regarding lung function and exacerbation rates.

中文翻译：

---

使用Twincer™吸入Colistin干粉：雾化的一种有效且对患者更友好的替代品

背景

抗菌药物（如妥布霉素和粘菌素）的雾化是治疗铜绿假单胞菌感染的囊性纤维化（CF）患者的基石。然而，雾化具有高的治疗负担。Twincer ^™是一种干粉吸入器，专门用于吸入诸如粘菌素的抗生素。这项研究的目的是比较在现实生活中成年CF患者使用Twincer与大肠粘膜素或妥布霉素雾化的Twincer的患者结局和经验。

方法

这是一项从2015年1月1日至2018年7月7日的回顾性研究。通过比较在开始Twincer之前平均4.1年的雾化治疗期间平均FEV ₁下降和恶化率与在Twincer进行的平均1.7年治疗期间的相同值比较，评估有效性。

结果

对21位患者进行了评估，其中12位患者可以包括在疗效分析中，共计20位患者年。在所有患者中，有71.4％的患者首选Twincer而不是雾化治疗。使用Twincer可获得较高的治疗依从性，平均依从率为92.5％。FEV _1的年度下降没有显着差异开始从雾化改为使用Twincer粉末吸入器之前和之后的％pred（中位数下降分别为-1.56 [-5.57–5.31]和1.35 [-8.45–6.36]），p = 0.45（线性混合效应模型） 。与使用雾化相比，在Twincer治疗期间的静脉内或静脉内和口服抗生素疗程总数没有明显差异（在Twincer治疗期间为1.68和2.49疗程，而在雾化期间为1.51和2.94疗程，p = 0.88和p = 0.63） 。

结论

与Twincer一起吸入Colistin干粉是雾化的更患者友好替代方案，在肺功能和恶化率方面，我们未观察到临床结局有显着差异。