Does maintenance azithromycin reduce asthma exacerbations? An individual participant data meta-analysis

Area of Science:

• Pulmonology
• Pharmacology
• Clinical Trials

Background:

• Preventing asthma exacerbations is a key treatment objective.
• Long-term azithromycin (macrolide antibiotic) is a potential therapeutic strategy.
• Asthma subphenotypes (noneosinophilic, eosinophilic, severe) require tailored management.

Purpose of the Study:

• To systematically review and conduct an individual participant data (IPD) meta-analysis.
• To evaluate azithromycin's efficacy in reducing asthma exacerbations.
• To assess efficacy across distinct asthma subphenotypes.

Main Methods:

• Systematic search of major databases (Embase, MEDLINE, PubMed, Cochrane) and trial registries.
• Inclusion of parallel-group, double-blind, randomized controlled trials (RCTs) of azithromycin vs. placebo (≥8 weeks treatment, ≥6 months follow-up).
• IPD meta-analysis for exacerbations; random-effects meta-analysis for secondary outcomes.

Main Results:

• Three studies (n=604) met inclusion criteria.
• Azithromycin significantly reduced exacerbation rates (oral corticosteroid use, antibiotic use, hospitalizations, ED visits) in all asthma groups.
• Specific reductions observed: fewer oral corticosteroid courses in eosinophilic asthma; fewer antibiotic courses in noneosinophilic and severe asthma.

Conclusions:

• Maintenance azithromycin therapy effectively reduces exacerbations in patients with eosinophilic, noneosinophilic, and severe asthma.
• Azithromycin demonstrates a favorable safety profile.
• This supports azithromycin's role in managing recurrent asthma exacerbations.