Macrolides for asthma: A systematic review and meta-analysis of randomized trials.
Leonardo M Ologundudu, Melanie M Wong, Nazmul Islam et al.
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In 30 seconds
This systematic review and meta-analysis assessed the efficacy and safety of macrolides versus placebo or standard care for asthma, using 19 randomized trials involving 1825 participants. Macrolides improved asthma control: the between-group mean difference on the 6-item Asthma Control Questionnaire was -0.23 (95% CI -0.32 to -0.13), and 40.6% versus 21.6% improved by the minimally important difference. They likely reduced severe exacerbations and modestly improved quality of life, with little to no effect on serious adverse events or mortality. Relative effects were similar in type 2 high and type 2 low inflammation asthma.
Key findings
- Asthma control improved with macrolides: mean difference -0.23 (95% CI -0.32 to -0.13); 40.6% vs 21.6% achieved a minimally important improvement.
- Severe exacerbations were likely reduced: incidence rate ratio 0.75 (95% CI 0.57 to 0.98), or 0.26 fewer events per patient-year (95% CI 0.45 to 0.02 fewer).
- Quality of life likely improved modestly: mean difference 0.11 (95% CI -0.06 to 0.29); 47.6% vs 42.4% achieved a minimally important improvement.
- Macrolides had little to no effect on serious adverse events and mortality; relative effects were similar across type 2 inflammation groups.
Why it matters
The findings suggest macrolides may offer benefits across asthma control and exacerbation outcomes, including in both type 2 high and type 2 low inflammation asthma. The review also reports little to no difference in serious harms, while distinguishing stronger certainty for asthma control and serious safety outcomes from moderate certainty for exacerbations and quality of life.