Effects Of Long-term Macrolide Therapy In Stable COPD

Background:Chronic obstructive pulmonary disease(COPD)is currently the fourth disease causing deaths in the world and expected to rise to third place by 2020.Frequent acute exacerbations lead to increased mortality.Controlling and preventing the acute excerbation of COPD are important for improving the health condition of patients,delaying disease progression,and reducing the high disability and mortality.Macrolide antibiotics have achieved good clinical efficacy in the treatment of chronic airway inflammatory diseases such as diffuse panbronchiolitis(DPB),cystic fibrosis(CF),bronchiectasis,and asthma.Some suggestions for prophylactic use of macrolides in preventing COPD exacerbations have been raised,but there are still several issues that need to be addressed,such as target population,the course of treatment,therapeutic dose,and so on.Objective:To evaluate,via exploratory meta-analysis,the efficacy and the safety of long-term macrolide therapy in stable COPD.Methods:A systematic literature search was performed in Pub Med,Embase,Cochrane database,Chinese biomedical literature database,China national knowledge infrastructure database,Wanfang database and Weipu database from inception to March 28,2019.Randomized controlled trials(RCT)which reported the long term administration of macrolide antibiotics in prevention of COPD were eligible.Results:A total of 10 articles were included in this study.It was found that there was a 23% relative risk reduction in COPD exacerbations among patients taking macrolides compared to placebo(P<0.01).The median time to first exacerbation was effectively prolonged among patients taking macrolides vs placebo(P<0.01).Sub-group analysis showed erythromycin was advantageous and older patients were less responsive to macrolides.Conclusions:Long-term usage of macrolides could significantly reduce the frequency of acute exacerbation of COPD.The treatment was well tolerated,with few adverse reactions,but it was not suitable for the elderly.It is recommended that this treatment regimen could be used in patients with GOLD grading 3 or 4,because they have a higher risk of acute exacerbation and mortality.It needs to be further discussed whether this treatment should last for 12 months or longer.