Macrolides were evaluated using individual patient-level data on asthma control, as well as on severe exacerbations and harms1. Evidence certainty followed GRADE.
Across 19 trials (1825 patients), macrolides improved asthma control 40.6% vs placebo (21.6%); achieved a ≥ 0.5-point improvement (high certainty); likely reduced severe exacerbations (incidence rate ratio 0.75; moderate certainty); and modestly improved quality of life. Serious adverse events and mortality showed little to no difference. Effects were similar in type 2–high and type 2–low asthma.
Overall, macrolides likely reduce exacerbations and improve control (NNT ~ 5) with minimal serious harms.
Roxithromycin was studied in four studies, and Azithromycin in most of them. None of the older erythromycins were studied. The adverse effects of erythromycin (15-20%) are much higher than those of Roxithromycin (4-5%). It is presumed this is an anti-inflammatory effect, not an anti-bacterial effect.
As published in NZ Doctor and Research Review
