Adjunctive azithromcyn reduces asthma exacerbations

Author: Bruce Sylvester

Patients with persistent symptomatic asthma had fewer asthma exacerbations and improved quality of life when treated with oral azithromycin for 48 weeks, researchers on August 12, 2017 in The Lancet.

In the randomized, double-blind, placebo controlled AMAZES trial, the investigators sought to determine if oral azithromycin could decrease frequency of asthma exacerbations in adults (≥18 years) with symptomatic asthma, if added to treatment with inhaled corticosteroid and long-acting bronchodilator.

Potential subjects with hearing impairment or a prolonged corrected QTc interval were excluded, in order to minimize the risk of ototoxicity and cardiac arrhythmia.

Between June 12, 2009, and Jan 31, 2015, the investigators randomized 420 subjects, 213 to azithromycin and 207 to placebo. They received azithromycin 500 mg or placebo three times per week for 48 weeks.

Primary endpoints were the rate of total (severe and moderate) asthma exacerbations over 48 weeks and asthma quality of life.

They researchers reported that, compared to placebo, azithromycin significantly reduced total asthma exacerbations (1.07 per patient-year compared with placebo (1.86 per patient-year, p<0·0001).

The proportion of subjects reporting at least one asthma exacerbation was reduced significantly by azithromycin treatment (127 [61%] patients in the placebo group vs 94 [44%] patients in the azithromycin group, p<0·0001).

Azithromycin significantly improved asthma-related quality of life (p=0·001).

The authors concluded, “Azithromycin might be a useful add-on therapy in persistent asthma.”