Table 4—

Summary of randomised-controlled studies examining the clinical effectiveness of macrolide therapy in asthma

First author [ref.]Study designDrug regimenAdults/ children nLength of studyBenefit?Adverse effects (treatment arm)
Richeldi 44Meta-analysisInsufficient evidence for a conclusionNo difference in drug withdrawals or GI events
Simpson 45Randomised, double-blind, placebo-controlledClarithromycin 500 mg b.i.d.45/08 weeks↑QoL; ↓wheeze; FEV1 unchanged; BHR unchangedNot reported
Johnston 46Randomised, parallel group, double-blind, placebo-controlledTelithromycin 800 mg daily for 10 days278/06 weeks↓Symptom score; home PEF unchangedNo overall difference between groups (nausea more common (5.3%), ↑ALT+AST (n = 2))
Kostadima 47Randomised, double-blind, placebo-controlledClarithromycin250 mg b.i.d./t.i.d.63/0(all ICS)8 weeks↓BHR; FEV1 unchangedNot examined (GI disorder (n = 1))
Kraft 48Randomised, double-blind, placebo-controlledClarithromycin500 mg b.i.d.55/0(32% ICS)6 weeks↑FEV1 in PCR+ subjects (Mycoplasma pneumoniae or Chlamydia pneumoniae)Not examined
Black 49Randomised, double-blind, placebo-controlledRoxithromycin150 mg b.i.d.232/0(>75% ICS)6 weeks(6 month follow-up)Morning PEF unchanged; ↑evening PEF; symptom score unchangedNo overall difference between groups (diarrhoea/nausea more common, ↑ALT+AST (n = 2))
Amayasu 50Randomised, double-blind, placebo-controlled, crossoverClarithromycin200 mg b.i.d.17/0(no ICS)8 weeksFEV1 unchanged; ↓BHR; ↓symptom scoreNone
Shoji 51Randomised, double-blind, placebo-controlled, crossoverRoxithromycin150 mg b.i.d.14/0(no ICS)Two8-weekblocksFEV1 unchanged; BHR unchanged; ↓symptom scoreNone
Kamada 52Randomised, double-blind, parallel treatment armsTroleandomycin + methylprednisolone;troleandomycin + prednisone; methylprednisolone0/19(all ICS)12 weeksAll ↓steroid dose; ↓symptom score#; pulmonary function unchangedOne withdrawal due to abnormal LFT results
Nelson 7Double-blind, placebo-controlledTroleandomycin + methylprednisolone; methylprednisolone75/02 yrsNo 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.