Department of Pulmonary Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, People's Republic of China.
Department of Pulmonary Medicine, The Fouth People's Hospital of Taizhou, Taizhou, Jiangsu Province 225300, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2019 Jun 12;14:1289-1298. doi: 10.2147/COPD.S205075. eCollection 2019.
Chronic obstructive pulmonary disease (COPD) is currently the fourth largest fatal disease in the world, and is expected to rise to third place by 2020. Frequent acute exacerbations lead to increased mortality. Some suggestions for prophylactic use of macrolides in preventing COPD exacerbations have been raised, but there are still several issues that need to be addressed, such as target population, the course of treatment, therapeutic dose, and so on. To evaluate, via exploratory meta-analysis, the efficacy of long-term macrolide therapy at low doses in stable COPD. A systematic literature search was performed in PubMed, Embase, and Cochrane database from inception to March 28, 2019. Randomized controlled trials (RCT) which reported long-term use of macrolides in prevention of COPD were eligible. A total of 10 articles were included in this study. It was found that there was a 23% relative risk reduction in COPD exacerbations among patients taking macrolides compared to placebo (<0.01). The median time to first exacerbation was effectively prolonged among patients taking macrolides vs placebo (<0.01). Sub-group analysis showed erythromycin was advantageous and older patients were less responsive to macrolides. Long-term low dose usage of macrolides could significantly reduce the frequency of the acute exacerbation of COPD. The treatment was well tolerated, with few adverse reactions, but it was not suitable for the elderly. It is recommended that this treatment regimen could be used in patients with GOLD grading C or D, because they have a higher risk of acute exacerbation and mortality. It needs to be further discussed whether this treatment should last for 12 months or longer.
慢性阻塞性肺疾病（COPD）目前是世界上第四大致死疾病，预计到 2020 年将上升至第三位。频繁的急性加重导致死亡率增加。有人建议预防性使用大环内酯类药物预防 COPD 加重，但仍有几个问题需要解决，如目标人群、治疗疗程、治疗剂量等。通过探索性荟萃分析评估小剂量长期大环内酯类治疗对稳定期 COPD 的疗效。系统检索 PubMed、Embase 和 Cochrane 数据库，检索时间从建库至 2019 年 3 月 28 日。纳入报道长期使用大环内酯类预防 COPD 的随机对照试验（RCT）。共纳入 10 项研究。结果发现，与安慰剂相比，大环内酯类药物组 COPD 加重的相对风险降低了 23%（<0.01）。与安慰剂相比，大环内酯类药物组首次加重的中位时间有效延长（<0.01）。亚组分析显示红霉素有利，老年患者对大环内酯类药物反应较差。长期低剂量使用大环内酯类药物可显著降低 COPD 急性加重的频率。该治疗方案耐受性良好，不良反应较少，但不适合老年人。建议将该治疗方案用于 GOLD 分级 C 或 D 的患者，因为他们有更高的急性加重和死亡风险。还需要进一步讨论这种治疗是否需要持续 12 个月或更长时间。
