Summary of randomised-controlled studies examining the clinical effectiveness of macrolide therapy in asthma
| First author [ref.] | Study design | Drug regimen | Adults/ children n | Length of study | Benefit? | Adverse effects (treatment arm) |
| Richeldi 44 | Meta-analysis | Insufficient evidence for a conclusion | No difference in drug withdrawals or GI events | |||
| Simpson 45 | Randomised, double-blind, placebo-controlled | Clarithromycin 500 mg b.i.d. | 45/0 | 8 weeks | ↑QoL; ↓wheeze; FEV1 unchanged; BHR unchanged | Not reported |
| Johnston 46 | Randomised, parallel group, double-blind, placebo-controlled | Telithromycin 800 mg daily for 10 days | 278/0 | 6 weeks | ↓Symptom score; home PEF unchanged | No overall difference between groups (nausea more common (5.3%), ↑ALT+AST (n = 2)) |
| Kostadima 47 | Randomised, double-blind, placebo-controlled | Clarithromycin250 mg b.i.d./t.i.d. | 63/0(all ICS) | 8 weeks | ↓BHR; FEV1 unchanged | Not examined (GI disorder (n = 1)) |
| Kraft 48 | Randomised, double-blind, placebo-controlled | Clarithromycin500 mg b.i.d. | 55/0(32% ICS) | 6 weeks | ↑FEV1 in PCR+ subjects (Mycoplasma pneumoniae or Chlamydia pneumoniae) | Not examined |
| Black 49 | Randomised, double-blind, placebo-controlled | Roxithromycin150 mg b.i.d. | 232/0(>75% ICS) | 6 weeks(6 month follow-up) | Morning PEF unchanged; ↑evening PEF; symptom score unchanged | No overall difference between groups (diarrhoea/nausea more common, ↑ALT+AST (n = 2)) |
| Amayasu 50 | Randomised, double-blind, placebo-controlled, crossover | Clarithromycin200 mg b.i.d. | 17/0(no ICS) | 8 weeks | FEV1 unchanged; ↓BHR; ↓symptom score | None |
| Shoji 51 | Randomised, double-blind, placebo-controlled, crossover | Roxithromycin150 mg b.i.d. | 14/0(no ICS) | Two8-weekblocks | FEV1 unchanged; BHR unchanged; ↓symptom score | None |
| Kamada 52 | Randomised, double-blind, parallel treatment arms | Troleandomycin + methylprednisolone;troleandomycin + prednisone; methylprednisolone | 0/19(all ICS) | 12 weeks | All ↓steroid dose; ↓symptom score#; pulmonary function unchanged | One withdrawal due to abnormal LFT results |
| Nelson 7 | Double-blind, placebo-controlled | Troleandomycin + methylprednisolone; methylprednisolone | 75/0 | 2 yrs | No benefit | ↓Bone density; ↑glucose+cholesterol |
GI: gastrointestinal; QoL: quality of life; FEV1: forced expiratory volume in one second; BHR: bronchial hyperresponsiveness; PEF: peak expiratory flow; ALT: alanine aminotransferase; AST: aspartate aminotransferase; ICS: inhaled corticosteroid; LFT: liver function test. #: troleandomycin/methylprednisolone group.