Azithromycin Improves Remission Rates in Patients with Persistent Uncontrolled Asthma, claims study

Asthma remission has become an increasingly important treatment goal, especially in patients with persistent uncontrolled asthma. The AMAZES clinical trial evaluated the safety and efficacy of azithromycin in reducing asthma exacerbations. This post hoc analysis aimed at determining whether the addition of azithromycin to standard therapy might induce remission in this group of patients. Remission was defined by multiple criteria, including clinical and lung function measures.

This study represents an analysis of data from the AMAZES trial, a double-anonymized placebo-controlled trial. Patients were randomized to azithromycin or a placebo for 12 months. The definition used for clinical remission was no exacerbations or oral corticosteroid use in the past six months and an Asthma Control Questionnaire score of ≤ 1 at 12 months. Secondary definitions of remission were clinical remission with the addition of either lung function criteria post bronchodilator FEV1 ≥ 80% or ≤ 5% decline from baseline or complete remission, defined as a sputum eosinophil count of < 3% with the aforementioned criteria. Sensitivity analyses were carried out to provide robustness to these definitions, and predictors of remission were identified.

Key Findings

There were more patients in the azithromycin treatment group than in the placebo group who achieved clinical remission, including 50.6% versus 38.9% for placebo (P =.032).

• Additionally, a higher percentage of patients receiving azithromycin met the criteria for clinical remission plus lung function: 50.8% versus 37.1% for the placebo group (P =.029).

• Although not statistically significant, a significantly higher percentage of patients in the azithromycin group had complete remission than in the placebo arm: 23% vs 13.7%, respectively (P = .058).

• The sensitivity analyses supported the selected remission criteria and the study findings.

• Baseline factors such as better asthma-related quality of life and no oral corticosteroid bursts within the last year were major predictors and associated with higher odds for remission. The very important result was that azithromycin induced remission both in eosinophilic and noneosinophilic asthma.

Findings provide evidence that azithromycin may be helpful in adding to standard therapy in the management of patients with moderate-to-severe persistent asthma. The results are very encouraging, proving that attainment of remission is a very real possibility even in patients with chronic symptoms. The study has also been able to bring out the potential of remission being a primary treatment outcome and opened up further avenues for research in this direction. The improvement in lung function and reduction in exacerbations reported in this study fall within the broader remit of long-term disease control as an aim of asthma management.

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