Does long-term macrolide treatment reduce asthma exacerbations? An individual patient data meta-analysis

Abstract

Background: Eliminating exacerbations is an important goal of asthma treatment. Our aim was to conduct a systematic review and individual patient data (IPD) meta-analysis to examine whether macrolides reduce exacerbations in asthma, non-eosinophilic asthma, eosinophilic asthma and severe asthma. Methods: In February 2019, we systematically searched multiple databases for parallel-group double-blind randomised controlled trials in adults comparing at least 8 weeks of macrolide antibiotic treatment with placebo, where exacerbations were assessed over at least 6 months. Two authors screened studies, extracted data and assessed bias. A one-step IPD meta-analysis was conducted on available data. Results: Four studies were eligible and three provided data for IPD meta-analysis (AZISAST[1]; AMAZES[2]; AZMATICS). Macrolide treatment (azithromycin) reduced the exacerbation rate (oral corticosteroid or antibiotic use, hospitalisation and/or emergency room visit) in asthma (incident rate ratio [IRR]=0.61 [95%CI 0.49-0.78] p Conclusion: Long-term treatment with azithromycin reduces exacerbations, regardless of whether the patient has eosinophilic, non-eosinophilic or severe asthma.