Introduction Azithromycin is a macrolide with antibiotic and anti-inflammatory properties, which may reduce exacerbations and improves clinical outcomes in severe asthma. However, the target population and clinical utility of azithromycin in real life setting remain uncertain.
Aim To determine the efficacy and safety of long-term azithromycin treatment in severe asthma in real life setting.
Methods Patients attended a tertiary severe asthma between 2013 to 2016 were clinically characterised using pre-designed protocol and data were recorded on the dendrite system. The clinical outcomes of patients treated by long-term azithromycin (≥4 months) were compared for the 12 months before and 12 months on treatment using parametric and non-parametric analysis.
Results Out of a total number of 259 patients entered on the registry, 46 (17.7%) patients had long- term azithromycin treatment. The mean age of this group was 50 years. (range 25–72), 33 (66%) females, mean BMI 32±8.4 kg/M2, 41 (80%) had infective phenotype (≥4 LRTI per annum and/or chronic productive cough), 13 (23%) had CT-scan confirmed bronchiectasis, mean ICS 1620 mcg/day and 13 (26%) were on maintenance OCS. The mean FEV1=1.96 L±0.73,%predicted FEV1=69.4±24.3, mean FEV1/FVC ratio 64.6±16.5, mean FeNO 26±27.2 ppb, mean blood eosinophil 0.3*109/l, and mean blood neutrophil was 6.2±2.2*109/l. We observed significant reduction in the mean number of OCS requiring exacerbation in the 12 months on treatment compared to the 12 months pre-treatment (figure 1). There was also significant reduction in LRTI frequency from median=4.5 per annum to 1.0 (p<0.00001) and hospital admissions from mean of 1.17±2.4 to 0.24±0.7 (p=0.01). Also statistically non-significant improvement in ACQ-7 mean 3.5±1.26 to 3.18±1.3 (p=0.09) and FEV1 1.72 to 1.91 (p=0.36). The treatment was generally well tolerated with 35 (76%) of patients had positive response, whilst 11 patients (23.9%) discontinued due to lack of benefit (n=8) or side effects (n=3).
Conclusion Long-term azithromycin therapy improved clinical outcomes in this sub-population of severe asthma of infective phenotype with acceptable safety profile. Further research is warranted to confirm these findings.
The Lancet. doi:10.1016/s0140-6736(17)31281-3
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.