Macrolides for the long-term management of asthma - A meta-analysis of randomized clinical trials

J. Reiter, N. Demirel, A. Mendy, J. Gasana, E. R. Vieira, Andrew Colin, A. Quizon, E. Forno

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Background Macrolide antibiotics, which have anti-inflammatory and immune modulatory effects, have been studied as adjuncts for the management of asthma. However, results have been contradictory and trials underpowered. We therefore sought to conduct a meta-analysis of randomized controlled trials (RCT). Methods All RCT of prolonged macrolides (3+ weeks) for asthma treatment, published up to January 2013 in MEDLINE, Scopus, CINAHL, Highwire, and The Cochrane Collaboration Library, were included. Fixed- or random-effects models were used to calculate pooled weighted or standard mean differences (WMD or SMD, respectively). Results A total of 12 studies were included for analysis. The pooled effect of macrolides on FEV1 (eight trials, 381 subjects) was not significant (SMD 0.05, 95% CI -0.14-0.25), but there was a significant increase in peak expiratory flow (four trials, 419 subjects; WMD 6.7, 95% CI 1.35-12.06). Pooled analysis also showed significant improvements in symptom scores (eight studies, 478 subjects; WMD -0.46, 95% CI -0.60 to -0.32), quality of life (five trials, 346 subjects; WMD 0.18, 95% CI 0.001-0.37), and airway hyper-reactivity (two trials, 131 subjects; SMD 1.99, 95% CI 0.46-3.52). Post hoc evaluation showed limited statistical power to detect significant differences in FEV1. Conclusions Macrolide administration for asthma for three or more weeks was not associated with improvement in FEV1, but produced significant improvements in peak expiratory flow, symptoms, quality of life, and airway hyper-reactivity. Macrolides may therefore be beneficial as adjunct asthma therapy. Future trials, focusing on long-term safety and effectiveness, should use standardized outcomes and procedures.

Original languageEnglish
Pages (from-to)1040-1049
Number of pages10
JournalAllergy: European Journal of Allergy and Clinical Immunology
Volume68
Issue number8
DOIs
StatePublished - Aug 1 2013

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Macrolides
Meta-Analysis
Asthma
Randomized Controlled Trials
Quality of Life
MEDLINE
Libraries
Anti-Inflammatory Agents
Anti-Bacterial Agents
Safety

Keywords

  • anti-asthmatic agents
  • asthma
  • macrolides
  • meta-analysis

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

Cite this

Macrolides for the long-term management of asthma - A meta-analysis of randomized clinical trials. / Reiter, J.; Demirel, N.; Mendy, A.; Gasana, J.; Vieira, E. R.; Colin, Andrew; Quizon, A.; Forno, E.

In: Allergy: European Journal of Allergy and Clinical Immunology, Vol. 68, No. 8, 01.08.2013, p. 1040-1049.

Research output: Contribution to journalArticle

Reiter, J, Demirel, N, Mendy, A, Gasana, J, Vieira, ER, Colin, A, Quizon, A & Forno, E 2013, 'Macrolides for the long-term management of asthma - A meta-analysis of randomized clinical trials', Allergy: European Journal of Allergy and Clinical Immunology, vol. 68, no. 8, pp. 1040-1049. https://doi.org/10.1111/all.12199
Reiter, J. ; Demirel, N. ; Mendy, A. ; Gasana, J. ; Vieira, E. R. ; Colin, Andrew ; Quizon, A. ; Forno, E. / Macrolides for the long-term management of asthma - A meta-analysis of randomized clinical trials. In: Allergy: European Journal of Allergy and Clinical Immunology. 2013 ; Vol. 68, No. 8. pp. 1040-1049.
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abstract = "Background Macrolide antibiotics, which have anti-inflammatory and immune modulatory effects, have been studied as adjuncts for the management of asthma. However, results have been contradictory and trials underpowered. We therefore sought to conduct a meta-analysis of randomized controlled trials (RCT). Methods All RCT of prolonged macrolides (3+ weeks) for asthma treatment, published up to January 2013 in MEDLINE, Scopus, CINAHL, Highwire, and The Cochrane Collaboration Library, were included. Fixed- or random-effects models were used to calculate pooled weighted or standard mean differences (WMD or SMD, respectively). Results A total of 12 studies were included for analysis. The pooled effect of macrolides on FEV1 (eight trials, 381 subjects) was not significant (SMD 0.05, 95{\%} CI -0.14-0.25), but there was a significant increase in peak expiratory flow (four trials, 419 subjects; WMD 6.7, 95{\%} CI 1.35-12.06). Pooled analysis also showed significant improvements in symptom scores (eight studies, 478 subjects; WMD -0.46, 95{\%} CI -0.60 to -0.32), quality of life (five trials, 346 subjects; WMD 0.18, 95{\%} CI 0.001-0.37), and airway hyper-reactivity (two trials, 131 subjects; SMD 1.99, 95{\%} CI 0.46-3.52). Post hoc evaluation showed limited statistical power to detect significant differences in FEV1. Conclusions Macrolide administration for asthma for three or more weeks was not associated with improvement in FEV1, but produced significant improvements in peak expiratory flow, symptoms, quality of life, and airway hyper-reactivity. Macrolides may therefore be beneficial as adjunct asthma therapy. Future trials, focusing on long-term safety and effectiveness, should use standardized outcomes and procedures.",
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N2 - Background Macrolide antibiotics, which have anti-inflammatory and immune modulatory effects, have been studied as adjuncts for the management of asthma. However, results have been contradictory and trials underpowered. We therefore sought to conduct a meta-analysis of randomized controlled trials (RCT). Methods All RCT of prolonged macrolides (3+ weeks) for asthma treatment, published up to January 2013 in MEDLINE, Scopus, CINAHL, Highwire, and The Cochrane Collaboration Library, were included. Fixed- or random-effects models were used to calculate pooled weighted or standard mean differences (WMD or SMD, respectively). Results A total of 12 studies were included for analysis. The pooled effect of macrolides on FEV1 (eight trials, 381 subjects) was not significant (SMD 0.05, 95% CI -0.14-0.25), but there was a significant increase in peak expiratory flow (four trials, 419 subjects; WMD 6.7, 95% CI 1.35-12.06). Pooled analysis also showed significant improvements in symptom scores (eight studies, 478 subjects; WMD -0.46, 95% CI -0.60 to -0.32), quality of life (five trials, 346 subjects; WMD 0.18, 95% CI 0.001-0.37), and airway hyper-reactivity (two trials, 131 subjects; SMD 1.99, 95% CI 0.46-3.52). Post hoc evaluation showed limited statistical power to detect significant differences in FEV1. Conclusions Macrolide administration for asthma for three or more weeks was not associated with improvement in FEV1, but produced significant improvements in peak expiratory flow, symptoms, quality of life, and airway hyper-reactivity. Macrolides may therefore be beneficial as adjunct asthma therapy. Future trials, focusing on long-term safety and effectiveness, should use standardized outcomes and procedures.

AB - Background Macrolide antibiotics, which have anti-inflammatory and immune modulatory effects, have been studied as adjuncts for the management of asthma. However, results have been contradictory and trials underpowered. We therefore sought to conduct a meta-analysis of randomized controlled trials (RCT). Methods All RCT of prolonged macrolides (3+ weeks) for asthma treatment, published up to January 2013 in MEDLINE, Scopus, CINAHL, Highwire, and The Cochrane Collaboration Library, were included. Fixed- or random-effects models were used to calculate pooled weighted or standard mean differences (WMD or SMD, respectively). Results A total of 12 studies were included for analysis. The pooled effect of macrolides on FEV1 (eight trials, 381 subjects) was not significant (SMD 0.05, 95% CI -0.14-0.25), but there was a significant increase in peak expiratory flow (four trials, 419 subjects; WMD 6.7, 95% CI 1.35-12.06). Pooled analysis also showed significant improvements in symptom scores (eight studies, 478 subjects; WMD -0.46, 95% CI -0.60 to -0.32), quality of life (five trials, 346 subjects; WMD 0.18, 95% CI 0.001-0.37), and airway hyper-reactivity (two trials, 131 subjects; SMD 1.99, 95% CI 0.46-3.52). Post hoc evaluation showed limited statistical power to detect significant differences in FEV1. Conclusions Macrolide administration for asthma for three or more weeks was not associated with improvement in FEV1, but produced significant improvements in peak expiratory flow, symptoms, quality of life, and airway hyper-reactivity. Macrolides may therefore be beneficial as adjunct asthma therapy. Future trials, focusing on long-term safety and effectiveness, should use standardized outcomes and procedures.

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