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Azithromycin May Reduce Treatment Failure in Patients With Acute Exacerbation of COPD

Jaime Rosenberg
A randomized controlled trial found that patients hospitalized for an acute exacerbation of chronic obstructive poulmonary disease (COPD) experienced reduced rates of treatment failure when adding azithromycin to their standard of care.
Azithromycin may offer relief for patients with chronic obstructive pulmonary disease (COPD), according to a randomized controlled trial, which found that the antibiotic can reduce treatment failure in patients hospitalized with acute exacerbation of the disease.

During the study, patients received a low dose of azithromycin in addition to their prescribed medications while in the hospital and continued taking the antibiotic for 3 months following hospitalization. The result, according to the data, was reduced treatment failure compared with standard of care alone. Rates of treatment failure were under 50% for patients taking azithromycin (49%) compared with 60% for patients receiving standard of care.

“Previous studies have shown that azithromycin prevents acute COPD exacerbations, but whether that antibiotic could reduce the need to intensify care of patients hospitalized for an exacerbation or improve their chances of not having another exacerbation once they left the hospital was unclear,” according to a press release.

Patients receiving azithromycin also spent 24% fewer days in the hospital and 74% fewer days in the intensive care unit. These findings were more prominent among smokers compared with nonsmokers. The study also examined the impact of withdrawing azithromycin at the end of 3 months, finding that the clinical benefits of the antibiotic were lost after 6 months.

A total of 301 patients were enrolled at 20 Belgian hospitals between April 2014 and April 2017, with the azithromycin arm receiving 500 mg per day for 3 days while hospitalized and then receiving 250 mg twice weekly for 3 months following hospital discharge.

Mortality was 2% in the azithromycin arm compared with 4% in the standard of care arm.

The researchers noted that because they did not attain their goal of enrolling 500 patients in the study, the trial was unable to demonstrate statistical significance for time to treatment failure, its primary endpoint. However, “a positive message of the trial is that our strategy reduced hospital time, days in the ICU, and recurrent exacerbations in the most severe COPD group,” Wim Janssens, MD, PhD, professor of medicine at KU Leven, pulmonologist at University Hospitals Leuven, and senior author of the study, said in a statement.

According to Janssens, a large phase 4 study with hospital readmission as the primary endpoint is necessary before broad implementation of the current study’s findings.

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