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Azithromycin during Acute Chronic Obstructive Pulmonary Disease Exacerbations Requiring Hospitalization (BACE). A
Kristina Vermeersch1,2, Maria Gabrovska3, Joseph Aumann4
1Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing.
Summary
Azithromycin treatment for hospitalized acute exacerbations of COPD (AECOPD) may reduce treatment failure within three months. However, clinical benefits of azithromycin were lost after treatment cessation, suggesting prolonged use is necessary.
Area of Science:
- Pulmonology
- Infectious Diseases
- Pharmacology
Background:
- Azithromycin is known to prevent acute exacerbations of chronic obstructive pulmonary disease (AECOPD).
- The efficacy of azithromycin in treating hospitalized AECOPD remains unclear.
- This study addresses the gap in understanding azithromycin's role in managing severe AECOPD.
Purpose of the Study:
- To evaluate if a 3-month low-dose azithromycin intervention reduces treatment failure in hospitalized AECOPD patients.
- To assess the impact of azithromycin when added to standard care upon hospital admission.
Main Methods:
- A multicenter, randomized, double-blind, placebo-controlled trial involving 301 patients hospitalized for AECOPD.
- Patients received azithromycin or placebo for 3 months, in addition to standard care (corticosteroids, antibiotics).
- Treatment failure was defined as a composite endpoint including treatment intensification, hospital care escalation, readmission, or mortality, assessed over 3 and 6 months.
Main Results:
- The 3-month treatment failure rate was 49% with azithromycin versus 60% with placebo (HR, 0.73; P=0.0526).
- Azithromycin significantly reduced treatment intensification (47% vs 60%, P=0.0272) and step-up in hospital care (13% vs 28%, P=0.0024).
- Clinical benefits observed during treatment diminished by 6 months after drug withdrawal.
Conclusions:
- A 3-month course of azithromycin initiated during hospitalization for infectious AECOPD may significantly decrease treatment failure.
- Prolonged azithromycin treatment appears necessary to sustain clinical benefits in AECOPD patients.
- Further research into optimal duration and patient selection for azithromycin therapy in AECOPD is warranted.
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