British Thoracic Society guideline for the use of long-term macrolides in adults with respiratory disease

Smith, David L.; Rand, I A Du; Addy, C.; Collyns, Timothy; Hart, Simon P.; Mitchelmore, Philip; Rahman, Najib M.; Saggu, Ravijyot

doi:10.1136/bmjresp-2019-000489

Cited by 24 publications

(27 citation statements)

References 2 publications

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“…Severe asthma is currently a guideline criterion for macrolide treatment [1][2][3]. Fig 5 presents evidence that Cp biomarkers, whether IgG, IgA or IgE, are associated with increasing asthma severity in a somewhat linear fashion.…”

Section: Discussionmentioning

confidence: 99%

“…Macrolides are now included in the Global Initiative for Asthma (GINA) [1], European Respiratory Society/American Thoracic Society (ERS/ATS) [2], and British Thoracic Society (BTS) [3] guidelines as treatment options for severe asthma. Macrolide mechanism(s) of action in asthma are currently unknown and could include immunomodulatory, anti-viral, or antimicrobial effects [4].…”

Section: Introductionmentioning

confidence: 99%

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Chlamydia pneumoniae and chronic asthma: Updated systematic review and meta-analysis of population attributable risk

Hahn

2021

PLoS ONE

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Background Chlamydia pneumoniae (Cp) is an obligate intracellular human respiratory pathogen producing persisting lung infection with a plausible link to asthma pathogenesis. The population attributable risk of potentially treatable Cp infection in asthma has not been reported. Methods The author searched from 2000 to 2020 inclusive for previously un-reviewed and new cross sectional and prospective controlled studies of Cp biomarkers and chronic asthma in both children and adults. Qualitative descriptive results and quantitative estimates of population attributable risk for selected biomarkers (specific IgG, IgA and IgE) are presented. Findings No large, long-term prospective population-based studies of Cp infection and asthma were identified. About half of case-control studies reported one or more significant associations of Cp biomarkers and chronic asthma. Heterogeneity of results by age group (pediatric v adult asthma), severity category (severe/uncontrolled, moderate/partly controlled, mild/controlled) and antibody isotype (specific IgG, IgA, IgE) were suggested by the qualitative results and confirmed by meta-analyses. The population attributable risks for Cp-specific IgG and IgA were nul in children and were 6% (95% confidence interval 2%-10%, p = 0.002) and 13% (9%-18%, p<0.00001) respectively in adults. In contrast to the nul or small population attributable risks for Cp-specific IgG and IgA, the population attributable risk for C. pneumoniae-specific IgE (children and adults combined) was 47% (39%-55%, p<0.00001). In the subset of studies that reported on asthma severity categories, Cp biomarkers were positively and significantly (P<0.00001) associated with asthma severity. Interpretation C. pneumoniae-specific IgE is strongly associated with asthma and asthma severity, suggesting a possible mechanism linking chronic Cp infection with asthma in a subset of individuals with asthma. Infection biomarkers should be included in future macrolide treatment trials for severe and uncontrolled asthma.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chlamydia pneumoniae and chronic asthma: Updated systematic review and meta-analysis of population attributable risk

Hahn

2021

PLoS ONE

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“…Though IgRT is beneficial in reducing infections in SAD patients, 7–11 and its efficacy in comparison to prophylactic antibiotic therapy is unknown. There is an increasing weight of evidence showing that prophylactic antibiotics are of value in patients with chronic respiratory disease, in particular, bronchiectasis 12 . It is likely that recurrent infection in patients with SAD due to HD is multifactorial 13 .…”

Section: Figurementioning

confidence: 99%

Impact of stopping long‐term immunoglobulin therapy in patients with secondary antibody deficiency due to haematological disease

et al. 2021

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“…5-7 They are widely used both in bacterial pneumonia due to their antimicrobial activity and in chronic inflammatory lung disease due to their immunomodulatory effects. 8,9 In addition, azithromycin has in vitro antiviral activity against a range of viruses including SARS-CoV-2. 10,11…”

Section: Introductionmentioning

confidence: 99%

Azithromycin in Hospitalised Patients with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Horby

Roddick

Spata

et al. 2020

Preprint

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SUMMARYBackgroundAzithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We evaluated the efficacy and safety of azithromycin in hospitalised patients with COVID-19.MethodsIn this randomised, controlled, open-label, adaptive platform trial, several possible treatments were compared with usual care in patients hospitalised with COVID-19 in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once daily by mouth or intravenously for 10 days or until discharge (or one of the other treatment arms). Patients were twice as likely to be randomised to usual care as to any of the active treatment groups. The primary outcome was 28-day mortality. The trial is registered with ISRCTN (50189673) and clinicaltrials.gov (NCT04381936).FindingsBetween 7 April and 27 November 2020, 2582 patients were randomly allocated to receive azithromycin and 5182 patients to receive usual care alone. Overall, 496 (19%) patients allocated to azithromycin and 997 (19%) patients allocated to usual care died within 28 days (rate ratio 1·00; 95% confidence interval [CI] 0·90-1·12; p=0·99). Consistent results were seen in all pre-specified subgroups of patients. There was no difference in duration of hospitalisation (median 12 days vs. 13 days) or the proportion of patients discharged from hospital alive within 28 days (60% vs. 59%; rate ratio 1·03; 95% CI 0·97-1·10; p=0·29). Among those not on invasive mechanical ventilation at baseline, there was no difference in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (21% vs. 22%; risk ratio 0·97; 95% CI 0·89-1·07; p=0·54).InterpretationIn patients hospitalised with COVID-19, azithromycin did not provide any clinical benefit. Azithromycin use in patients hospitalised with COVID-19 should be restricted to patients where there is a clear antimicrobial indication.FundingUK Research and Innovation (Medical Research Council) and National Institute of Health Research (Grant ref: MC_PC_19056).

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British Thoracic Society guideline for the use of long-term macrolides in adults with respiratory disease

Cited by 24 publications

References 2 publications

Chlamydia pneumoniae and chronic asthma: Updated systematic review and meta-analysis of population attributable risk

Chlamydia pneumoniae and chronic asthma: Updated systematic review and meta-analysis of population attributable risk

Impact of stopping long‐term immunoglobulin therapy in patients with secondary antibody deficiency due to haematological disease

Azithromycin in Hospitalised Patients with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

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