Patients with COPD who experience frequent exacerbations are typically presented with two treatment options for prevention, per clinical guidelines: azithromycin or roflumilast.
A new paper from researchers at UCLA, “Comparative Effectiveness of Azithromycin Versus Roflumilast in Patients With Chronic Obstructive Pulmonary Disease: Emulated Target Trial,” analyzed both treatments in an effort to better guide patient care. The paper was published in BMJ.
Researchers used data from the Optum Cliniformatics Mart Database of patients 40 years and older with active COPD who had initiated a new oral prescription for maintenance with either of the two treatments between 2011 and 2024.
A total of 7,750 matched pairs of patients using each type of treatment were included in the cohort. Compared with roflumilast, azithromycin was associated with a 17% reduction in the hazard of the first moderate or severe COPD exacerbation.
The researchers concluded that azithromycin was associated with a reduced likelihood of moderate or severe COPD exacerbations compared with roflumilast use.
William Feldman, MD, pulmonologist and health services researcher at UCLA Health and senior author of the study, said in a UCLA news article that it is important to study the differences between the two medications to better guide patient treatment.
“While both treatments have been found to reduce exacerbations, there has been little data available to guide clinicians about which option is best,” he said. “Our findings help fill the gap by providing data that can better inform treatment decisions.”
“These findings highlight differences in treatment effectiveness that may help contextualize clinical decision-making when considered alongside safety evidence,” the authors wrote.
While azithromycin was found to be preferable in clinical practice to reduce COPD exacerbations, the researchers cautioned that the overall benefit-risk assessments require further investigation.
