Macrolide Therapy Decreases Chronic Obstructive Pulmonary Disease Exacerbation: A Meta-Analysis

Abstract

Background: Macrolide antibiotics have anti-inflammatory effects, and long-term administration may reduce chronic obstructive pulmonary disease (COPD) exacerbations. Objective: To investigate the effects of long-term treatment of macrolide therapy for COPD. Methods: We searched the PubMed and Embase databases to identify randomized controlled trials that evaluated the effect of macrolide therapy (of at least 2 weeks) for COPD. The primary outcome assessed was the frequency of acute exacerbations during follow-up. Results: Six trials involving 1,485 COPD patients were included in the analysis. Analysis of the pooled data of all 6 trials showed that macrolide administration reduced the frequency of acute exacerbations of COPD [risk ratio (RR) = 0.62; 95% CI 0.43-0.89, p = 0.01]. Subgroup analysis showed that only erythromycin might be associated with decreased COPD exacerbations (erythromycin: p = 0.04, azithromycin: p = 0.22, clarithromycin: p = 0.18). Moreover, macrolide therapy for 3 months did not significantly reduce the number of exacerbations (p = 0.18), whereas a beneficial effect was conclusive in the 6-month (p = 0.009) and 12-month (p = 0.03) treatment subgroups. In addition, nonfatal adverse events were more frequent in the macrolide treatment groups than in the controls (RR = 1.32; 95% CI 1.06-1.64, p = 0.01). However, related clinical factors had no influence on the overall result (p = 0.19). There was no publication bias among the included trials. Conclusions: Macrolide therapy was effective and safe in decreasing the frequency of exacerbations in patients with COPD. Treatment might provide a significant benefit but only when therapy lasts more than 6 months.

Neutrophils and emerging targets for treatment in chronic obstructive pulmonary disease

“…Other interesting results were obtained with macrolide therapy, such as azithromycin in the treatment of exacerbations. However, these type of drugs seem only to have beneficial effects when administered for periods longer than 6 months [123]. A more specific approach to target neutrophils is the use of monoclonal antibodies directed against IL-8 [124].…”

Prophylactic Use of Macrolide Antibiotics for the Prevention of Chronic Obstructive Pulmonary Disease Exacerbation: A Meta-Analysis

“…To confirm this hypothesis, several randomized controlled trials (RCTs) were launched, yielding various results. Prior meta-analyses evaluated these researches in general and concluded that the prophylactic use of antibiotics can lower the frequency of exacerbations in patients with COPD [ 10 , 11 ]. However, several questions still remain unanswered, such as the most appropriate drug, the best regimen for its administration, and the most suitable target population.…”

Management of airway mucus hypersecretion in chronic airway inflammatory disease: Chinese expert consensus (English edition)

“…52 Long-term administration of erythromycin (250 mg, twice daily), azithromycin (250 mg, once daily), and other macrolides helps reduce the frequency of acute exacerbations in COPD patients and improves their quality of life, and evidence-based medicine has also confirmed the clinical value of macrolides for reducing the occurrence of acute COPD exacerbations. 53 – 55 Although no official guidelines include macrolides among classical expectorants, the available evidence suggests that macrolides can be recommended for achieving antibiotic effects and sputum clearance in COPD patients who require antibiotics. 56 Evidence also suggests that macrolides have limited ability to improve lung function, but they can improve airway hyperresponsiveness in asthma patients.…”