Abstract

Background: Bronchiectasis (BE) guidelines recommend long term macrolide treatment for patients with ≥3 exacerbations/year without P aeruginosa infection. Randomized controlled trials (RCTs) suggest that long term macrolide treatment can prevent exacerbations in adult patients with BE but these studies have been too small to conduct meaningful subgroup analyses. Aims: To explore macrolide benefit in subpopulations, including those where macrolide therapy is not currently recommended, using individual patient data (IPD) meta-analysis. Methods: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Web of Science were searched to identify RCT’s of macrolide antibiotics for at least 3 months with a primary outcome of BE exacerbations. IPD meta-analysis was performed using fixed effects models adjusting for age, sex, FEV1 and trial. Results: IPD was obtained for 341 participants in 3 RCTs. Macrolides reduced the frequency of exacerbations adjusted incidence rate ratio (IRR) 0.49 95% CI 0.36-0.66,p Conclusions: Long-term macrolide treatment significantly reduces the rate of exacerbations in patients with BE with similar benefits observed in all subgroups based on patient characteristics.

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