Effectiveness and safety of macrolides in bronchiectasis patients: a meta-analysis and systematic review - PubMed (original) (raw)
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Effectiveness and safety of macrolides in bronchiectasis patients: a meta-analysis and systematic review
Zu-Liang Shi et al. Pulm Pharmacol Ther. 2014 Aug.
Abstract
Purpose: Macrolides has been studied as a potential therapeutic anti-inflammatory agent for bronchiectasis patients, which has used as an immunoregulation agent. However, the efficacy and safety results of macrolides across available randomized controlled trials (RCTs) are controversial. The aim of this systematic review is to evaluate the efficacy and safety of macrolides in bronchiectasis.
Methods: RCTs of macrolides treatment for the patients of bronchiectasis published in PubMed and Cochrane Library were searched. Two authors independently extracted data and assessment the methodological quality. The primary efficacy outcome was the impact on the number of pulmonary exacerbation. Safety outcomes included adverse events and mortality.
Results: Seven RCTs were found in the systematic review and six studies were included in the present meta-analysis. Macrolides treatment showed a significant reduced rate of pulmonary exacerbation (RR = 0.55, 95%CI = 0.43-0.70) compared with control groups. However, subgroup analysis failed to find any significant changes in total 46 patients (RR = 0.20, 95%CI = 0.03-1.58) for treatment not more than 3 months. The incidence rates of total adverse events showed no significant difference among the macrolides group and control groups.
Conclusions: Long-term treatment of bronchiectasis with macrolides can reduce incidence of pulmonary exacerbation, especially in the subgroup treatment 6 months or more. There was no evidence of increased adverse events with macrolides. However, to verify the best macrolides regimen, more studies based on larger sample size and stratified by ethnicity are still needed.
Chemical compounds studied in this article: Erythromycin (PubChem CID 12560); Azithromycin (PubChem CID: 447043); Clarithromycin (PubChem CID: 84029); Roxithromycin (PubChem CID: 5480431).
Keywords: Azithromycin; Bronchiectasis; Erythromycin; Macrolides; Pulmonary exacerbation; Roxithromycin.
Copyright © 2013 Elsevier Ltd. All rights reserved.
Comment in
- Macrolide treatment in patients with bronchiectasis: more attention should be paid to the number of exacerbations.
Gao YH, Guan WJ, Xu G, Chen RC. Gao YH, et al. Pulm Pharmacol Ther. 2014 Apr;27(2):213-4. doi: 10.1016/j.pupt.2013.12.004. Epub 2014 Jan 5. Pulm Pharmacol Ther. 2014. PMID: 24397907 No abstract available. - Letter to the editor: inaccurate data in meta-analysis of macrolides by Shi et al.
Serisier DJ. Serisier DJ. Pulm Pharmacol Ther. 2014 Aug;28(2):179. doi: 10.1016/j.pupt.2013.12.006. Epub 2014 Jan 8. Pulm Pharmacol Ther. 2014. PMID: 24412272 No abstract available. - Reply to "Letter to the Editor" by Serisier regarding "effectiveness and safety of macrolides in bronchiectasis patients: a meta-analysis and systematic review".
Shi ZL, Peng H, Hu JG. Shi ZL, et al. Pulm Pharmacol Ther. 2014 Aug;28(2):180-1. doi: 10.1016/j.pupt.2014.04.001. Epub 2014 Apr 13. Pulm Pharmacol Ther. 2014. PMID: 24731870 No abstract available.
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