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Effects of long-term use of macrolides in patients with non-cystic fibrosis bronchiectasis: a meta-analysis of randomized controlled trials

 

Research article

Li-Chao Fan?, Hai-Wen Lu?, Ping Wei, Xiao-Bin Ji, Shuo Liang and Jin-Fu Xu*

  • *
    Corresponding author: Jin-Fu Xu jfxucn@gmail.com

  • ? Equal contributors

Author Affiliations

Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai 200433, China

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BMC Infectious Diseases 2015, 15:160 
doi:10.1186/s12879-015-0872-5

Li-Chao Fan and Hai-Wen Lu contributed equally to this work.

Published: 27 March 2015

Abstract (provisional)

Background The purpose of this study was to evaluate the clinical benefits and safety
of the long-term use of macrolides in patients with non-cystic fibrosis (non-CF) bronchiectasis.
Methods Embase, Pubmed, the Cochrane Library and Web of Science databases were searched
from inception up to March 2014. The primary outcome was the improvement of exacerbations
of bronchiectasis. Secondary endpoints included changes of microbiology, lung function,
quality of life, sputum volume, adverse events and macrolide resistance. Results The
literature search yielded 139 studies, ten of which containing 601 patients were included
in this meta-analysis. Macrolides showed a statistically-significant improvement in
reducing acute exacerbations per patient during follow-up treatment (RR?=?0.55, 95%
CI: 0.47, 0.64, P?lt;?0.001), increasing the number of patients free from exacerbations
(OR?=?2.81, 95% CI: 1.85, 4.26, P?lt;?0.001), and prolonging time to a first exacerbation
(HR?=?0.38, 95% CI: 0.28, 0.53, P?lt;?0.001). Macrolides maintenance treatment was
superior to control with respect to attenuating FEV1 decline (p?=?0.02), improving
sputum volume (p?=?0.009) and SGRQ total scores (p?=?0.02), but showed a higher risk
of adverse events, especially diarrhea (OR?=?5.36; 95% CI: 2.06, 13.98, P?=?0.0006).
Eradication of pathogens was improved in the macrolide group (OR?=?1.76, 95% CI: 0.91,
3.41, P?=?0.09), while pathogen resistance caused by macrolides dramatically increased
(OR?=?16.83, 95% CI: 7.26, 38.99, P?lt;?0.001). The new appearance of a microbiologic
profile or participant withdrawal due to adverse events showed no significant differences
between the two groups. Conclusion In patients with non-CF bronchiectasis, macrolide
maintenance treatment can effectively reduce frequency of exacerbations, attenuate
lung function decline, decrease sputum volume, improve quality of life, but may be
accompanied with increased adverse events (especially diarrhea) and pathogen resistance.