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. 2025 Jan 17;80(2):113-116.
doi: 10.1136/thorax-2024-221977.

Effects of azithromycin in severe eosinophilic asthma with concomitant monoclonal antibody treatment

Gabriel Lavoie  1 , Imran Howell  1 , James Melhorn  1 , Catherine Borg  1 , Laura Bermejo-Sanchez  1 , Jack Seymour  1 , Maisha F Jabeen  1 , Anastasia Fries  1 , Gareth Hynes  1 , Ian D Pavord  1 , Nayia Petousi  1 , Timothy Sc Hinks  2
Affiliations

Effects of azithromycin in severe eosinophilic asthma with concomitant monoclonal antibody treatment

Gabriel Lavoie et al. Thorax. .

Abstract

Macrolides reduce exacerbations when added to inhaled therapy in severe asthma. However, there is little published evidence for effectiveness in patients treated with biologics. We conducted a retrospective audit of all patients who started azithromycin while on biologics in our centre. Compared with those that did not start azithromycin, these individuals had more exacerbations and a phenotype of chronic bronchitis and/or frequent purulent exacerbations. The addition of azithromycin to biologics was associated with reduced annual rates of steroid-treated and antibiotic-treated exacerbations and improved symptom scores (Asthma Control Questionnaire-5) but not with any improvement in lung function. Data support testing azithromycin in clinical trials in patients on biologics with residual exacerbations.

Keywords: Asthma; Asthma Pharmacology; Bacterial Infection; Respiratory Infection.

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Conflict of interest statement

Competing interests: The research was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. TSCH is supported by a Wellcome Trust Fellowship (211050/Z/18/z). TSCH has received funding from Pfizer for conduct of a trial of azithromycin in COVID. IDP has received speaker’s honoraria for speaking at sponsored meetings from Astra Zeneca, Aerocrine, Almirall, Sanofi/Regeneron, Menarini and GSK and payments for organising educational events from AZ, GSK and Sanofi/Regeneron. He has received honoraria for attending advisory panels with Sanofi/Regeneron, Astra Zeneca, GSK, Merck, Circassia, Chiesi and Areteia. He has received sponsorship to attend international scientific meetings from GSK, Astra Zeneca and Sanofi/Regeneron. All other authors do not declare any conflicts of interests.

Figures

Figure 1
Figure 1. Change in median annual rates of oral corticosteroids (OCS) and antibiotic-requiring events before and after biologics and before and after azithromycin. A and B Biologics reduced the median rate of OCS-treated events from 6 to 2 median difference (95% CI) of 4.0 (2.0 to 5.0) events/year (p<0.001)), but not of antibiotic-treated events (change from 3 to 2, median difference 2.0 (0.0 to 2.5) events/year (p=0.09)). C and D Azithromycin reduced the median rates of OCS-treated events from 2 to 1 (median difference of 0.3 (0.0 to 1.9) events/year (p<0.05)) and antibiotic treated-events from 2 to 1 (median difference 1.6 (1.0 to 2.0) events/year (p<0.001)).
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