Meta-analysis of macrolide maintenance therapy for prevention of disease exacerbations in patients with noncystic fibrosis bronchiectasis

Abstract

Background: Macrolide maintenance treatment remains controversial for patients with noncystic fibrosis (non-CF) bronchiectasis, we performed a meta-analysis to estimate the benefits and safety of macrolides therapy in adults and children with non-CF bronchiectasis. Methods: PubMed, Embase, the Cochrane Library, and Web of Science databases were searched for all the randomized controlled trials of macrolides for treating non-CF bronchiectasis. The primary outcome was improvement of bronchiectasis exacerbations. Secondary outcomes included adverse events and macrolide resistance. Results: A total of 10 studies involving 602 patients were included in the analysis. Pooled results showed that macrolide therapy significantly reduced the number of patients who suffered from exacerbations (RR=1.56, 95% CI=1.14-2.14, P=.006, I2=72%), number of patients who experienced at least 3 exacerbations (RR=0.55, 95% CI=0.39-0.77, P=.0005, I2=40%), average exacerbations per patient during the observation time (SMD=-0.69, 95% CI=-1.06 to -0.32, P=.0002, I2=60%), and bronchiectasis exacerbation-related admissions (RR=0.46, 95% CI=0.23-0.96, P=.04, I2=0%). Specified subgroup analyses of the number of patients free from exacerbations were further performed; macrolide therapy showed a significant benefit in both children (RR 5.03, 95% CI 2.02-12.50, P=.0005, I2=45%) and adults (RR=1.66, 95% CI=1.37-2.02, P