Long-term macrolide therapy for chronic obstructive pulmonary disease: a population-based time series analysis

Area of Science:

• Pulmonary Medicine
• Pharmacology
• Health Services Research

Background:

• Macrolides are recommended for moderate to severe chronic obstructive pulmonary disease (COPD) with recurrent exacerbations.
• The MACRO trial (August 2011) demonstrated macrolide efficacy for this indication.
• Understanding temporal trends in macrolide therapy provision is crucial.

Purpose of the Study:

• To examine temporal trends in long-term macrolide therapy for COPD patients.
• To assess changes in macrolide use before and after the MACRO trial publication.
• To evaluate the impact on COPD exacerbations and healthcare utilization.

Main Methods:

• Interrupted time series analysis of population-level health administrative data.
• Cohort: Ontario residents aged 65+ with COPD using long-acting inhalers (2004-2018).
• Primary outcome: Prevalence of long-term macrolide therapy; Secondary outcomes: COPD-related hospitalizations, ED visits, and exacerbations.

Main Results:

• Long-term macrolide use increased from 0.8 to 13.8 per 1000 people (2004-2018).
• The rate of increase in macrolide prophylaxis accelerated significantly post-2011.
• No detectable reduction in COPD-related hospitalizations or emergency department visits was observed.

Conclusions:

• A significant rise in long-term macrolide therapy for COPD has occurred.
• Continued monitoring of benefits, adverse events, and antimicrobial resistance is essential.
• The clinical impact on exacerbation rates and healthcare burden requires further investigation.