- Title
- Does maintenance azithromycin reduce asthma exacerbations? An individual participant data meta-analysis
- Creator
- Hiles, Sarah A.; McDonald, Vanessa M.; Guilhermino, Michelle; Brusselle, Guy G.; Gibson, Peter G.
- Relation
- The European Respiratory Journal Vol. 54, Issue 5, no. 1901381
- Publisher Link
- http://dx.doi.org/10.1183/13993003.01381-2019
- Publisher
- European Respiratory Society
- Resource Type
- journal article
- Date
- 2019
- Description
- 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 the sub-phenotypes of non-eosinophilic asthma, eosinophilic asthma and severe asthma. Method: We completed a systematic search of EMBASE, Medline, Pubmed, Cochrane Library, ClinicalTrails.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. PROSPERO registration: CRD42018075259. Results: Three studies were identified (N=597). 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 room visits) in asthma and in the non-eosinophilic, eosinophilic and severe asthma subgroups. Examining each exacerbation type separately, patients with eosinophilic asthma reported fewer oral corticosteroids courses and patients with non-eosinophilic and severe asthma reported fewer antibiotic courses. Azithromycin was well tolerated. Discussion: Maintenance use of azithromycin reduces exacerbations in patients with eosinophilic, non-eosinophilic and severe asthma.
- Subject
- asthma; azithromycin; placebo; exacerbations; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1462361
- Identifier
- uon:46451
- Identifier
- ISSN:0903-1936
- Language
- eng
- Reviewed
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