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Macrolide prescribing and preemptive electrocardiograms in asthma, COPD, ACO, and general population: a
Victor Pera1, Heleen Lepouttre1,2, Cesar Barboza1
1Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.
Objective:
Macrolides are used in patients with chronic respiratory conditions to prevent exacerbations. However, due to their QT interval prolonging effect, an electrocardiogram (ECG) assessment prior to long-term treatment is recommended. The objective was to evaluate the incidence of macrolides use (azithromycin, clarithromycin, erythromycin) in individuals with asthma, chronic obstructive pulmonary disease (COPD), asthma-COPD overlap (ACO), and to assess the frequency of ECGs performed prior to long-term macrolide prescribing.
Methods:
We utilized data from the Dutch Integrated Primary Care Information (IPCI) database and Spanish Information System for Research in Primary Care (SIDIAP), between 2006 and 2022. The study population consisted of individuals diagnosed with asthma, COPD, and ACO with ≥365 days follow-up after diagnosis. Incidence was analyzed by type of macrolide, database, year, and prescribing-duration (short-, medium-, long-term [<30, 30-179, ≥180 days]).
Results:
SIDIAP included 224,783 individuals with asthma, 167,524 with COPD, and 34,475 with ACO, while IPCI included 66,383 with asthma, 26,805 with COPD, and 7250 with ACO. The incidence of short-term use per 100,000 person-years (PYs) was 3500-6700 for azithromycin, 1300-2100 for clarithromycin and 200-300 for erythromycin. The incidence of medium- and long-term use was less than <1100/100,000 PYs. Incidence rates were higher in SIDIAP, females, and 60-79 year-olds. Medium- and long-term use was 2- to 4-fold higher in COPD and ACO than asthma, and increased over time. Database-registered ECGs were found in less than 1% of long-term macrolide users.
Conclusions:
Long-term macrolide users were on the rise among COPD- and ACO individuals; however, ECG monitoring was rare, raising concerns given guideline recommendations.
Insights
Long-term macrolide use for chronic respiratory conditions like COPD and asthma is increasing, but electrocardiogram (ECG) monitoring before treatment remains rare, despite guidelines recommending it due to potential heart risks.
Area of Science:
- Respiratory Medicine
- Pharmacology
- Cardiology
Background:
- Macrolides are prescribed for chronic respiratory diseases to prevent exacerbations.
- Long-term macrolide use necessitates electrocardiogram (ECG) assessment due to potential QT interval prolongation.
Purpose of the Study:
- To determine the incidence of macrolide use (azithromycin, clarithromycin, erythromycin) in asthma, COPD, and asthma-COPD overlap (ACO).
- To assess the frequency of ECGs performed before initiating long-term macrolide therapy.
Main Methods:
- Utilized data from the Dutch IPCI and Spanish SIDIAP databases (2006-2022).
- Analyzed incidence by macrolide type, database, year, and duration of use (short-, medium-, long-term).
- Included individuals with asthma, COPD, and ACO with at least 365 days follow-up.
Main Results:
- Short-term macrolide incidence per 100,000 person-years varied: azithromycin (3500-6700), clarithromycin (1300-2100), erythromycin (200-300).
- Medium- and long-term use incidence was <1100/100,000 person-years, higher in COPD and ACO than asthma.
- Fewer than 1% of long-term macrolide users had a recorded ECG prior to treatment.
Conclusions:
- Long-term macrolide prescriptions are increasing in COPD and ACO populations.
- Electrocardiogram (ECG) monitoring is infrequently performed before long-term macrolide use, contravening guidelines.
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