Efficacy and safety of macrolide therapy for adult asthma: A systematic review and meta-analysis.

Adult Asthma Azithromycin Clarithromycin Exacerbation Macrolide

Journal

Respiratory investigation
ISSN: 2212-5353
Titre abrégé: Respir Investig
Pays: Netherlands
ID NLM: 101581124

Informations de publication

Date de publication:
09 Jan 2024
Historique:
received: 06 10 2023
revised: 29 11 2023
accepted: 25 12 2023
medline: 12 1 2024
pubmed: 12 1 2024
entrez: 11 1 2024
Statut: aheadofprint

Résumé

The evidence for macrolide therapy in adult asthma is not properly established and remains controversial. We conducted a systematic review and meta-analysis to examine the efficacy and safety of macrolide therapy for adult asthma. We searched randomized controlled trials from MEDLINE via the PubMed, CENTRAL, and Ichushi Web databases. The primary outcome was asthma exacerbation. The secondary outcomes were serious adverse events (including mortality), asthma-related quality of life (symptom scales, Asthma Control Questionnaire, and Asthma Quality of Life Questionnaire), rescue medication (puffs/day), respiratory function (morning peak expiratory flow, evening peak flow, and forced expiratory volume in 1 s), bronchial hyperresponsiveness, and minimum oral corticosteroid dose. Of the 805 studies, we selected seven studies for the meta-analysis, which was conducted using a random-effects model. University Hospital Medical Information Network Clinical Trials Registry (UMIN000050824). No significant difference between macrolide and placebo for asthma exacerbations was observed (risk ratio 0.71, 95 % confidence interval [CI] 0.46-1.09; p = 0.12). Macrolide therapy for adult asthma showed a significant improvement in rescue medication with short-acting beta-agonists (mean difference -0.41, 95 % CI -0.78 to -0.04; p = 0.03). Macrolide therapy did not show more serious adverse events (odd ratio 0.61, 95 % CI 0.34-1.10; p = 0.10) than those with placebo. The other secondary outcomes were not significantly different between the macrolide and placebo groups. Macrolide therapy for adult asthma may be more effective than placebo and could be a treatment option.

Sections du résumé

BACKGROUND BACKGROUND
The evidence for macrolide therapy in adult asthma is not properly established and remains controversial. We conducted a systematic review and meta-analysis to examine the efficacy and safety of macrolide therapy for adult asthma.
METHODS METHODS
We searched randomized controlled trials from MEDLINE via the PubMed, CENTRAL, and Ichushi Web databases. The primary outcome was asthma exacerbation. The secondary outcomes were serious adverse events (including mortality), asthma-related quality of life (symptom scales, Asthma Control Questionnaire, and Asthma Quality of Life Questionnaire), rescue medication (puffs/day), respiratory function (morning peak expiratory flow, evening peak flow, and forced expiratory volume in 1 s), bronchial hyperresponsiveness, and minimum oral corticosteroid dose. Of the 805 studies, we selected seven studies for the meta-analysis, which was conducted using a random-effects model.
SYSTEMATIC REVIEW REGISTRATION BACKGROUND
University Hospital Medical Information Network Clinical Trials Registry (UMIN000050824).
RESULTS RESULTS
No significant difference between macrolide and placebo for asthma exacerbations was observed (risk ratio 0.71, 95 % confidence interval [CI] 0.46-1.09; p = 0.12). Macrolide therapy for adult asthma showed a significant improvement in rescue medication with short-acting beta-agonists (mean difference -0.41, 95 % CI -0.78 to -0.04; p = 0.03). Macrolide therapy did not show more serious adverse events (odd ratio 0.61, 95 % CI 0.34-1.10; p = 0.10) than those with placebo. The other secondary outcomes were not significantly different between the macrolide and placebo groups.
CONCLUSIONS CONCLUSIONS
Macrolide therapy for adult asthma may be more effective than placebo and could be a treatment option.

Identifiants

DOI: 10.1016/j.resinv.2023.12.015 PMID: 38211545
pubmed: 38211545
pii: S2212-5345(24)00008-X
doi: 10.1016/j.resinv.2023.12.015
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

206-215

Informations de copyright

Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors have no conflicts of interest.

Auteurs

Yosuke Fukuda (Y)

Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan; Department of Medicine, Division of Respiratory Medicine, Yamanashi Red Cross Hospital, Yamanashi, Japan. Electronic address: yosukefukuda.showa@gmail.com.

Nobuyuki Horita (N)

Chemotherapy Center, Yokohama City University Hospital, Kanagawa, Japan.

Masaharu Aga (M)

Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan.

Fumihiro Kashizaki (F)

Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Kanagawa, Japan.

Yu Hara (Y)

Department of Pulmonology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.

Yasushi Obase (Y)

Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Akio Niimi (A)

Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.

Takeshi Kaneko (T)

Department of Pulmonology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.

Hiroshi Mukae (H)

Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Hironori Sagara (H)

Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan.

Classifications MeSH