Asthma
Lauren Howell, PharmD
Adults with persistent symptomatic asthma achieved a higher rate of remission when treated with azithromycin, according to an analysis published in the August 2024 issue of CHEST. Data from the analysis showed that azithromycin, a medication that pharmacists are already familiar with, may be the key to remission for these patients.
As novel treatment approaches for asthma have more recently become available, goals for treatment have transitioned from achieving fewer exacerbations and preventing disease progression to that of achieving clinical remission. While previous studies have shown that biologics may have the potential to help patients attain remission, little research has been published regarding the role that azithromycin may play toward this goal.
Study design
The study was performed as a secondary analysis of the Asthma and Macrolides: The Azithromycin Efficacy and Safety (AMAZES) clinical trial data. Participants in the study included adults with symptomatic asthma despite treatment with inhaled corticosteroids and long-acting bronchodilators and without hearing impairment or an abnormal QT interval. The treatment group received 500 mg of azithromycin three times a week for 48 weeks as add-on therapy to their current regimen. Participants were followed for data collection for 12 months.
Clinical remission was defined as zero exacerbations (no asthma-related hospitalizations and no oral corticosteroid bursts), zero oral corticosteroid use, and a 5-item Asthma Control Questionnaire (ACQ-5) score of less than or equal to one at 12 months.
A significantly higher proportion (50.6%) of patients achieved remission while receiving azithromycin compared with those who received placebo (38.9%). Baseline factors such as better asthma-related quality of life and absence of oral corticosteroid burst in the previous year were found to play a role in which patients had the greatest odds of achieving clinical remission.
Azithromycin was found to induce remission in both patients with eosinophilic asthma and those with non-
eosinophilic asthma.
Application to pharmacy practice
The results provide evidence that on-treatment clinical remission is a realistic possibility and should be a goal for patients with asthma who are treated with long-term azithromycin. According to the study data, nine patients had to be treated with azithromycin to achieve one additional patient with clinical remission.
Previous studies have investigated the use of various biologics to induce remission, with remission rates in these studies ranging from 15% to 38%. Participants from the azithromycin study were able to achieve a higher rate of remission (50.6%) on a medication that is cheaper, more accessible, and available orally.
Downsides to long-term azithromycin use include the potential for antimicrobial resistance and cardiac, sensory, and GI adverse effects that are commonly seen with macrolide antibiotics.
According to the study authors, future studies should consider including a longer follow-up time to evaluate how disease stabilization and relapse may depend on the length of remission. Additionally, the impact of asthma remission on underlying asthma pathology such as bronchial hyper-responsiveness and smooth muscle thickness remains to be seen. ■