A systematic review and meta-analysis of macrolides in the management of adult patients with asthma

IF 6.2 2区医学 Q1 ALLERGY Allergology International Pub Date : 2024-01-30 DOI:10.1016/j.alit.2024.01.002

Hiroshi Ohnishi , Toshihito Otani , Yoshihiro Kanemitsu , Tatsuya Nagano , Johsuke Hara , Masamitsu Eitoku

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Abstract

Background

The efficacy of macrolides in the management of asthma has been studied but remains controversial. We conducted a systematic review and meta-analysis of macrolides in the management of adult patients with asthma.

Methods

Randomized controlled trials of macrolides used in adult patients with asthma were searched for in MEDLINE, EMBASE, PsycINFO, Cochrane Library, CINAHL, and Igaku Chuo Zasshi databases to evaluate the efficacy and safety of macrolides.

Results

Seventeen reports with macrolide treatment durations ranging from 6 to 48 weeks were included. Macrolides did not reduce exacerbations requiring hospitalization, severe exacerbations, or rescue use of short-acting beta-2 agonist inhalers; improve lung function; decrease peripheral blood or sputum neutrophil counts; or decrease fractional exhaled nitric oxide compared to placebo. Macrolides statistically improved asthma control and quality of life but by less than the minimal clinically important difference. Peripheral blood eosinophil counts as well as serum and sputum eosinophilic cationic protein concentrations were significantly decreased with macrolides compared to placebo. The improvement of asthma symptoms and airway hyperresponsiveness varied by study. The safety profile of macrolides was comparable to that of placebo.

Conclusions

Although macrolides have some useful clinical aspects, there is not sufficient evidence to recommend their use in the management of adult patients with asthma.

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大环内酯类药物治疗成年哮喘患者的系统回顾和荟萃分析

背景对大环内酯类药物治疗哮喘的疗效进行了研究，但仍存在争议。方法在 MEDLINE、EMBASE、PsycINFO、Cochrane Library、CINAHL 和 Igaku Chuo Zasshi 等数据库中检索大环内酯类药物用于成人哮喘患者的随机对照试验，以评估大环内酯类药物的疗效和安全性。与安慰剂相比，大环内酯类药物不能减少需要住院治疗的病情加重、严重病情加重或短效β2受体激动剂吸入剂的抢救使用；不能改善肺功能；不能降低外周血或痰中中性粒细胞计数；也不能降低呼出一氧化氮的分数。据统计，大环内酯类药物可改善哮喘控制和生活质量，但改善幅度小于最小临床重要性差异。与安慰剂相比，大环内酯类药物能显著降低外周血嗜酸性粒细胞计数以及血清和痰中嗜酸性粒细胞阳离子蛋白浓度。不同研究对哮喘症状和气道高反应性的改善程度各不相同。大环内酯类药物的安全性与安慰剂相当。结论虽然大环内酯类药物在临床方面有一些作用，但没有足够的证据建议将其用于成年哮喘患者的治疗。

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来源期刊

Allergology International ALLERGY-IMMUNOLOGY

CiteScore

12.60

自引率

5.90%

发文量

审稿时长

29 weeks

期刊介绍： Allergology International is the official journal of the Japanese Society of Allergology and publishes original papers dealing with the etiology, diagnosis and treatment of allergic and related diseases. Papers may include the study of methods of controlling allergic reactions, human and animal models of hypersensitivity and other aspects of basic and applied clinical allergy in its broadest sense. The Journal aims to encourage the international exchange of results and encourages authors from all countries to submit papers in the following three categories: Original Articles, Review Articles, and Letters to the Editor.