When treated with oral azithromycin for 48 weeks, adults with persistent symptomatic asthma experienced fewer asthma exacerbations and improved quality of life, a recent study found.
The randomized, double-blind, placebo controlled parallel group trial included 420 adult patients aged ≥18 years between June 12, 2009 and January 31, 2015, with symptomatic asthma despite use of inhaled corticosteroid and long-acting bronchodilator and who had no hearing impairment or abnormal prolongation of the corrected QT interval. Patients were randomly assigned 1:1 to receive azithromycin 500 mg (n=213) or placebo (n=207) 3 times per week for 48 weeks. Researchers found:
- Azithromycin reduced asthma exacerbations compared with placebo (1.07 vs 1.86 per patient year; incidence rate ratio [IRR] 0.59).
- The proportion of patients experiencing at least 1 asthma exacerbation was reduced by azithromycin treatment.
- Azithromycin significantly improved asthma-related quality of life.
Gibson PG, Yang IA, Upham JW, et al. Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMEZES): a randomized, double-blind, placebo-controlled trial. [Published online ahead of print July 4, 2017]. Lancet. doi:10.1016/S0140-6736(17)31281-3.
Despite the availability of excellent treatments like inhaled corticosteroids and long acting bronchodilators, there are many patients who still have sub-optimal control of their asthma. The first step in evaluating sub-optimal asthma control should be to inquire about adherence to taking the prescribed inhaler as directed. If a patient is taking their combination ICS/LABA inhaler, and potential environmental and allergic contributors to asthma have been assessed, the available agents include anti-IgE therapy with omalizumab and the new class of anti-IL5 agents (mepolizumab and reslizumab). This randomized blinded study of azithromycin convincingly shows a substantial benefit to azithromycin 500 mg 3 times a week in decreasing both severe and non-severe exacerbations by about 40%, as well as improving asthma-related quality of life. This fits with and extends previous studies that suggest macrolides have anti-inflammatory, antibacterial, and antiviral effects.1 This study is solid enough to consider azithromycin as a potential therapeutic option, recognizing that it is not FDA approved for this indication, for patients who continue to have symptoms despite current maximal therapy for asthma. —Neil Skolnik, MD
- Brusselle GG, Joos G. Is there a role for macrolides in severe asthma? Curr Opin Pulm Med. 2014;95–102.
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