RT Journal Article
SR Electronic
T1 Benefit–harm analysis of azithromycin for the prevention of acute exacerbations of chronic obstructive pulmonary disease
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 1079
OP 1087
DO 10.1136/thoraxjnl-2021-217962
VO 77
IS 11
A1 Safa Ahmadian
A1 Don D Sin
A1 Larry Lynd
A1 Mark Harrison
A1 Mohsen Sadatsafavi
YR 2022
UL http://thorax.bmj.com/content/77/11/1079.abstract
AB Background Low-dose oral azithromycin therapy is recommended as a preventive treatment for acute exacerbations of COPD. However, the overall benefit–harm balance of this treatment has not been well studied.Methods A probabilistic Markov model of COPD was created to simulate the course of COPD over 20 years. The model was populated with evidence from the literature and dedicated data analysis. The benefit of azithromycin was modelled as a reduction in exacerbation rates. Adverse events, including cardiovascular events, hearing loss, gastrointestinal symptoms and antimicrobial resistance (leading to a gradual decline in the effectiveness of azithromycin), were considered. All outcomes were assigned a health-related utility weight to estimate the overall net change in the quality-adjusted life year (QALY) associated with the use of azithromycin.Results In patients with a positive exacerbation history, azithromycin resulted in a net QALY gain of 17.9 per 100 patients (99.8% probability of expected QALY gain) over 20 years. The net benefit increased to 21.8 QALYs per 100 patients (99.9% probability of expected QALY gain) among the ‘frequent exacerbator’ subgroup. Azithromycin was not net beneficial among those without any moderate/severe exacerbations in the previous year. Findings were robust against series of sensitivity, scenario and threshold analyses.Conclusions Long-term therapy with azithromycin confers a net benefit to ex-smoker patients with COPD with a recent history of exacerbations and an even larger benefit to those who are frequent exacerbators.The computer code generating all the results presented in this work is available from https://github.com/safaahmadian/AZT_HarmBenefitAnalysis. One section of the code (the analysis of ECLIPSE data) is based on data that were obtained under license and the data cannot be shared.