Department of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
Department of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.
BMJ Open Respir Res. 2020 Feb;7(1). doi: 10.1136/bmjresp-2019-000535.
Although bacteria contribute significantly to acute exacerbations of chronic obstructive pulmonary disease (AECOPD), the added value of antibiotics remains controversial, especially in outpatient settings. Age may affect antibiotic effectiveness, but real-world evidence is lacking. We aimed to assess the influence of age on the effectiveness of doxycycline for AECOPD.
A retrospective cohort study among outpatients with the first recorded AECOPD treated with oral corticosteroids was conducted using a large pharmacy dispensing database. The primary outcome was treatment failure within 15-31 days after treatment start. Secondary outcome was time to second exacerbation. All analyses were stratified by age groups.
We identified 6300 outpatients with the first AECOPD. 2261 (36%) received doxycycline and 4039 (64%) did not receive any antibiotic (reference group). Overall, there was no difference in treatment failure (adjusted OR: 0.97, 95% CI: 0.84 to 1.12) between two groups. Similarly, no difference in treatment failure was observed in younger groups. However, in patients with advanced age (≥75 years), treatment failure was significantly reduced by doxycycline compared with reference (16% vs 20%, adjusted OR: 0.77, 95% CI: 0.62 to 0.97). Overall, median time to second exacerbation was 169 days (95% CI: 158 to 182 days) in doxycycline group compared with 180 days (95% CI: 169 to 191 days) in reference group (adjusted HR: 1.06, 95% CI: 0.99 to 1.12). Although in older patients there was a trend within 3 months towards longer time of next exacerbation by doxycycline, it did not achieve statistical significance.
Our findings showed short-term treatment benefit of doxycycline added to oral corticosteroids for chronic obstructive pulmonary disease patients with advanced age. This value remains unclear for persons aged under 75 years in current primary care. Long-term preventive benefits of doxycycline for the next exacerbation were not observed, irrespective of age.
虽然细菌对慢性阻塞性肺疾病（COPD）的急性加重（AECOPD）有重要影响，但抗生素的附加价值仍存在争议，尤其是在门诊环境中。年龄可能会影响抗生素的疗效，但缺乏真实世界的证据。我们旨在评估年龄对多西环素治疗 AECOPD 的疗效的影响。
我们使用大型药房配药数据库进行了一项回顾性队列研究，纳入了首次记录的 AECOPD 并接受口服皮质类固醇治疗的门诊患者。主要结局是治疗开始后 15-31 天内治疗失败。次要结局是第二次加重的时间。所有分析均按年龄组分层。
我们共纳入 6300 例首次 AECOPD 的门诊患者。2261 例（36%）接受了多西环素治疗，4039 例（64%）未接受任何抗生素（对照组）。总体而言，两组之间治疗失败的发生率没有差异（调整后的 OR：0.97，95%CI：0.84 至 1.12）。同样，在年龄较小的组中也没有观察到治疗失败的差异。然而，在年龄较大的患者（≥75 岁）中，与对照组相比，多西环素治疗显著降低了治疗失败率（16%比 20%，调整后的 OR：0.77，95%CI：0.62 至 0.97）。总体而言，多西环素组的中位第二次加重时间为 169 天（95%CI：158 至 182 天），对照组为 180 天（95%CI：169 至 191 天）（调整后的 HR：1.06，95%CI：0.99 至 1.12）。尽管在年龄较大的患者中，在 3 个月内多西环素组下一次加重的时间有延长的趋势，但未达到统计学意义。
我们的研究结果表明，对于年龄较大的慢性阻塞性肺疾病患者，在口服皮质类固醇的基础上加用多西环素治疗具有短期疗效。目前在初级保健中，对于年龄在 75 岁以下的患者，其价值尚不清楚。无论年龄大小，多西环素在预防下一次加重方面都没有长期获益。
