COPD patients do not benefit from azithromycin therapy longer than a year

A retrospective analysis of the COLUMBUS cohort found that prolonging azithromycin treatment over more than 1 year did not reduce COPD exacerbations.

The COLUMBUS trial included 92 adults with COPD who had ≥3 exacerbations within the year preceding the trial [1]. Treatment with 500 mg azithromycin or placebo 3 times a week over 12 months resulted in a significantly lower rate of exacerbation with a rate of 0.58 compared with placebo. The new question posed by Dr Sander Talman (Amphia Hospital, the Netherlands) and colleagues was whether continuing the bacteriostatic macrolide azithromycin for longer than 1 year would still entail an efficacious decrease in exacerbations [2].

The retrospective cohort study assigned the patients from the COLUMBUS investigation to a treatment or a control group, depending on their further therapy with azithromycin during the first year after the trial. Data was analysed for frequency of exacerbations, time to first incident, and number of in-patient hospital stays. In the azithromycin group, 34% of the study subjects had continued their azithromycin treatment.

There was no significant difference in mean values for exacerbation frequency between maintenance and non-maintenance group with 2.29 ± 2.43 and 1.67 ± 1.69 (P=0.577). Also, hospital admissions were not significantly influenced by further treatment with azithromycin >1 year: maintenance group vs non-maintenance group 0.56 ± 0.93 versus 1.36 ±1.91, respectively (P=0.307). The time to first exacerbation was shorter under azithromycin with a median of 138 days versus 168 days, but this difference also failed to reach statistical significance (P=0.11). The researchers concluded that administering azithromycin for a longer period than 12 months does not result in a beneficial decrease of exacerbations. The optimal macrolide treatment duration still needs to be determined in prospective investigations.

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   1. Uzun S, et al. Lancet Respir Med. 2014;2(5):361-8.
   2. Talman S, et al. OA3563, ERS 2019, 29 Sept-2 Oct, Madrid, Spain.

Posted on 28 November 201917 March 2021