Abstract
Background Preventing exacerbations is an important goal of asthma treatment. Long-term treatment with azithromycin may help achieve this. Our aim was to conduct a systematic review and individual participant data (IPD) meta-analysis to examine the efficacy of azithromycin in reducing exacerbations in asthma, and in the subphenotypes of noneosinophilic asthma, eosinophilic asthma and severe asthma.
Method We completed a systematic search of Embase, MEDLINE, PubMed, Cochrane Library, ClinicalTrials.gov and reference lists of previous systematic reviews in February 2019. We included parallel-group, double-blind, randomised controlled trials in adults comparing at least 8 weeks of azithromycin treatment with placebo, where the outcome of exacerbations was assessed over at least 6 months. Data were extracted from published sources, Cochrane Risk of Bias Tool was applied and IPD were sought from authors. Reviews were undertaken in duplicate. We conducted an IPD meta-analysis on the primary outcome of exacerbations and a random effects meta-analysis for secondary outcomes.
Results Three studies were identified (n=604). In the IPD meta-analysis, treatment with azithromycin was associated with a reduced rate of exacerbations (oral corticosteroid course due to worsening asthma, antibiotic use for lower respiratory tract infection, hospitalisation and/or emergency department visits) in asthma as well as in the noneosinophilic, eosinophilic and severe asthma subgroups. Examining each exacerbation type separately, patients with eosinophilic asthma reported fewer oral corticosteroid courses, and patients with noneosinophilic and severe asthma reported fewer antibiotic courses. Azithromycin was well tolerated.
Discussion Maintenance use of azithromycin reduces exacerbations in patients with eosinophilic, noneosinophilic and severe asthma.
Abstract
Maintenance use of azithromycin in conjunction with existing maintenance asthma treatment reduces exacerbations in severe asthma, eosinophilic asthma and noneosinophilic asthma http://bit.ly/2m8mnIx
Footnotes
This article has supplementary material available from erj.ersjournals.com
This study is registered at PROSPERO with identifier number CRD42018075259.
Author contributions: All authors contributed to data interpretation and critical review of the manuscript. P.G. Gibson, V.M. McDonald, G.G. Brusselle and S.A. Hiles contributed to conceiving the study, developing the research question and/or developing the study design. S.A. Hiles conducted the systematic literature search, article reviews, risk of bias assessment, data analysis, generated figures and tables, and drafted the manuscript. M. Guilhermino completed article reviews and risk of bias assessment. P.G. Gibson and G.G. Brusselle provided primary data.
Conflict of interest: S.A. Hiles: salary was supported by a grant from GlaxoSmithKline paid to employer (University of Newcastle) during the conduct of the study; travel for collaboration was supported by a Hunter Medical Research Institute Jennie Thomas Medical Research Travel Grant; salary was supported by a grant from AstraZeneca paid to employer (University of Newcastle) outside the submitted work.
Conflict of interest: V.M. McDonald reports grants from GlaxoSmithKline, during the conduct of the study; grants and personal fees for lectures from GlaxoSmithKline and AstraZeneca, personal fees for steering committee work from Menarini, outside the submitted work.
Conflict of interest: M. Guilhermino has nothing to disclose.
Conflict of interest: G.G. Brusselle reports personal fees for advisory board work and lectures from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Teva, personal fees for advisory board work from Sanofi, outside the submitted work.
Conflict of interest: P.G. Gibson reports grants and personal fees for educational activities from AstraZeneca, GlaxoSmithKline and Novartis, outside the submitted work.
- Received July 12, 2019.
- Accepted August 31, 2019.
- Copyright ©ERS 2019