Bronchiectasis · Long-term macrolides
Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis
| Design | Randomised, double-blind, placebo-controlled trial |
|---|---|
| Treatment | Azithromycin 500 mg three times per week |
| Control | Placebo |
| Population | 141 patients with non-cystic fibrosis bronchiectasis and at least one exacerbation in the past year |
| Follow-up | 6 months of treatment with follow-up to 12 months |
| Primary endpoint | Rate of event-based exacerbations |
| Result | Event-based exacerbations occurred at 0.59 per patient with azithromycin versus 1.57 with placebo over the 6-month treatment period — rate ratio 0.38 (95% CI 0.26 to 0.54, p<0.0001). Prebronchodilator FEV1 did not differ significantly, nor did St George's Respiratory Questionnaire score. |
| Secondary endpoints | FEV1, St George's Respiratory Questionnaire, adverse events, macrolide resistance |
Azithromycin is a new option for prevention of exacerbations in patients with non-cystic fibrosis bronchiectasis with a history of at least one exacerbation in the past year.
The trial authors, in the published abstract
One of three concordant macrolide trials in bronchiectasis with BAT and BLESS, and the effect size here is the largest. That neither lung function nor quality of life improved is worth saying out loud: this prevents attacks rather than making patients feel better day to day.
Wong C, Jayaram L, Karalus N, et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomised, double-blind, placebo-controlled trial. Lancet 2012 Aug 18;380(9842):660-7.