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Lung microbiome: new insights into bronchiectasis’ outcome



bronchiectasis copd :: Article Creator

In Bronchiectasis, Macrolide Maintenance Therapy Reduces Cardiovascular Events

Macrolide maintenance therapy (MMT) in patients with bronchiectasis significantly reduces the risk for major adverse cardiovascular events (MACE) and may possibly have a cardiovascular protective effect, according to study findings published in the European Respiratory Journal.

Investigators assessed the relationship between MMT treatment and MACE incidence (composite of stroke, myocardial infarction, and cardiovascular death) and the related safety outcome of the composite occurrence of sudden cardiac death and ventricular arrhythmias.

Investigators in Hong Kong conducted a retrospective, observational cohort study using the Clinical Data Analysis and Reporting System (CDARS) database, which includes 43 hospitals, 49 specialist outpatient clinics, and 73 general outpatient clinics, together comprising over 90% of Hong Kong's population. Diagnosis codes were used to identify adult patients diagnosed with bronchiectasis and treated with MMT from January 2001 through September 2018.

Included patients receiving macrolide antibiotics underwent 4 specific regimens, each for a minimum of 6 months (azithromycin 500 mg three times/week; azithromycin 250 mg daily; erythromycin 400 mg [equivalent to erythromycin base 250 mg] 2 times/day; and azithromycin 250 mg 3 times/week). Previous clinical trials had validated the efficacy of the first 3 regimens. The index date was defined as the date of a participant's first drug prescription.

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The administration of MMT in patients with bronchiectasis was associated with a significant reduction in the risk of MACE, without any evidence suggesting an increased risk of severe arrhythmia-related adverse events.

Overall, 3137 patients with bronchiectasis were propensity score-matched 1:2 into 2 cohorts: those who received MMT (n=1123) and those who did not (n=2014). The 2 cohorts were well-balanced in baseline characteristics with similar proportions of patients with cardiovascular complications and cardiovascular drug usage, as well as similar bronchiectasis duration and exacerbation frequency within 1 year prior to the index date.

The investigators found a significantly reduced risk of MACE associated with the use of MMT vs no use of MMT (16.38 vs 24.11 events/1000 person-years; hazard ratio [HR], 0.68; 95% CI, 0.52-0.90). No association was found between use vs nonuse of MMT and an increased risk for sudden cardiac death or ventricular arrhythmias (7.17 vs 7.67 events/1000 person-years; HR, 0.93; 95% CI, 0.60-1.44).

A significantly reduced risk for myocardial infarction was associated with the use vs non-use of MMT (5.33 vs 10.28 events/1000 person-years), as well as reduced risk of all-cause mortality (109.95 vs 132.04 events/1000 person-years).

Study limitations include the inability to assess bronchiectasis severity and the inability of the study's retrospective design to establish a causal relationship. Additionally, there was also risk for indication bias (ie, clinicians withholding MMT among patients deemed more likely to be at risk of MACE).

"The administration of MMT in patients with bronchiectasis was associated with a significant reduction in the risk of MACE, without any evidence suggesting an increased risk of severe arrhythmia-related adverse events," the investigators concluded. "These results suggest arrhythmogenic concerns related to MMT may be overstated and the potential cardiovascular protective effect of MMT in patients with bronchiectasis merits evaluation by future randomized study," the study authors added.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors' disclosures.





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