Long-Term Azithromycin Maintenance Treatment in Patients with Frequent Exacerbations of Chronic Obstructive Pulmonary Disease

Talman, Sander; Uzun, Sevim; Djamin, Remco S.; Baart, Sara J.; Grootenboers, Marco J.J.H.; Aerts, Joachim; Eerden, Menno van der

doi:10.2147/copd.s284397

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…Unfortunately, there were limited randomized controlled trials exploring the usage of macrolides for more than 12 months in COPD patients. A recent retrospective cohort study, following the COLUMBUS study, found no statistically significant difference between the group that received macrolides for 24 months and the group that received macrolides for 12 months before discontinuation [48]. Nevertheless, other retrospective studies have shown that the use of azithromycin 500 mg three times a week for 36 months reduced hospitalizations by 39% in COPD patients experiencing frequent exacerbations [49].…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness and Safety of Long-Term Macrolide Therapy for COPD in Stable Status: A Systematic Review and Meta-Analysis

Nakamura,

Fujita,

Chen

et al. 2023

Diseases

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Background: Chronic obstructive pulmonary disease (COPD) is a prevalent condition with fewer treatments available as the severity increases. Previous systematic reviews have demonstrated the benefits of long-term macrolide use. However, the therapeutic differences between different macrolides and the optimal duration of use remain unclear. Methods: A systematic review and meta-analysis were conducted to assess the effectiveness of long-term macrolide use in reducing COPD exacerbations, compare the therapeutic differences among macrolides, and determine the appropriate treatment duration. Four databases (PubMed, Cochrane Library, Web of Science, and ICHU-SHI) were searched until 20 March 2023, and a random-effects model was used to calculate the pooled effect. Results: The meta-analysis included nine randomized controlled trials involving 1965 patients. The analysis revealed an odds ratio (OR) of 0.34 (95% confidence interval [CI] 0.19, 0.59, p < 0.001) for the reduction in exacerbation frequency. Notably, only azithromycin or erythromycin showed suppression of COPD exacerbations. The ORs for reducing exacerbation frequency per year and preventing hospitalizations were −0.50 (95% CI: −0.81, −0.19; p = 0.001) and 0.60 (95% CI: 0.3, 0.97; p = 0.04), respectively. Statistical analyses showed no significant differences between three- and six-month macrolide prescriptions. However, studies involving a twelve-month prescription showed an OR of 0.27 (95% CI: 0.11, 0.68; p = 0.005; I2 = 81%). Although a significant improvement in St George’s Respiratory Questionnaire (SGRQ) total scores was observed with a mean difference of −4.42 (95% CI: −9.0, 0.16; p = 0.06; I2 = 94%), the minimal clinically important difference was not reached. While no adverse effects were observed between the two groups, several studies have reported an increase in bacterial resistance. Conclusions: Long-term use of azithromycin or erythromycin suppresses COPD exacerbations, and previous studies have supported the advantages of a 12-month macrolide prescription over a placebo.

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Section: Discussionmentioning

confidence: 99%

The Effectiveness and Safety of Long-Term Macrolide Therapy for COPD in Stable Status: A Systematic Review and Meta-Analysis

Nakamura,

Fujita,

Chen

et al. 2023

Diseases

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“…The combination of antibiotics and systemic steroids reduced in-hospital mortality and lowered the risk of readmission within 30 days. 9 The latest GOLD guideline 2022, 3 British Thoracic Society guideline 2020, 31 and several studies 32 , 33 suggest using low-dose macrolide therapy in patients with COPD in the following scenarios: (1) patients with more than three exacerbations per year requiring steroid therapy and (2) patients who had at least one exacerbation requiring hospital admission per year. Low-dose macrolide therapy can also be considered for a minimum duration of six months and up to 12 months to assess the impact on exacerbation rate.…”

Section: Discussionmentioning

confidence: 99%

Effect of Macrolide Antibiotics on In-Hospital Mortality Among Acute Exacerbation of COPD Patients: A Propensity Score-Matched Analysis

Morasert¹,

Kriengwattanakul²,

Kulalert³

2022

COPD

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Objective This study aimed to assess whether the short-term use of macrolide antibiotics during hospitalization can reduce in-hospital all-cause mortality compared to non-macrolide treatment in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A propensity score (PS) matching analysis was performed using retrospective data from the admission records of AECOPD patients in the medical general ward and medical intensive care unit of a tertiary care center between October 2015 and September 2018. The multivariable Cox proportional hazard model was performed to eliminate residual confounding after the PS analysis. Results The mortality rate was 11.1% of 1528 admissions in the PS matching cohort. Approximately 70% of patients had respiratory failure requiring intubation on initial admission, and 34% had pneumonia. Macrolide treatment significantly reduced in-hospital mortality among AECOPD patients (adjusted hazard ratio, 0.55; 95% confidence interval 0.32–0.96; P =0.034). Clarithromycin was the most commonly prescribed macrolide (80%). Conclusion Macrolide antibiotics reduced in-hospital mortality in hospitalized AECOPD patients. The combination of antimicrobial and immunomodulatory effects of macrolide treatment could play an essential role.

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Update on the pharmacological treatment of chronic obstructive pulmonary disease

Jacques,

Kuhn,

Albertson

2024

Expert Opinion on Pharmacotherapy

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Long-Term Azithromycin Maintenance Treatment in Patients with Frequent Exacerbations of Chronic Obstructive Pulmonary Disease

Abstract: Macrolides are effective in reducing the number of exacerbations in COPD patients with the frequent exacerbator phenotype. Our study did not show a persistent effect of azithromycin on exacerbation frequencies after more than one year of usage.

Cited by 5 publications

References 12 publications

The Effectiveness and Safety of Long-Term Macrolide Therapy for COPD in Stable Status: A Systematic Review and Meta-Analysis

The Effectiveness and Safety of Long-Term Macrolide Therapy for COPD in Stable Status: A Systematic Review and Meta-Analysis

Effect of Macrolide Antibiotics on In-Hospital Mortality Among Acute Exacerbation of COPD Patients: A Propensity Score-Matched Analysis

Update on the pharmacological treatment of chronic obstructive pulmonary disease

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