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Getting the latest healthcare news for you
Getting the latest healthcare news for you
For COPD patients prone to exacerbations, azithromycin may be the better oral maintenance option. A large emulated trial published in BMJ found that azithromycin reduced the risk of a first moderate or severe COPD exacerbation by 17% compared to roflumilast. Clinicians say the familiar antibiotic is also easier to prescribe and better tolerated than its counterpart.
For patients with COPD who keep having flare-ups despite maximal inhaler therapy, guidelines offer two oral maintenance options: azithromycin or roflumilast. But which one works better? A new emulated target trial published in BMJ — drawing on over a decade of real-world data — suggests azithromycin has the edge.
Researchers at UCLA matched 7,550 COPD patients on azithromycin with 7,550 on roflumilast and tracked their outcomes. Azithromycin users had a 17% lower risk of a first moderate or severe exacerbation and also fared better on combined hospital admission or death. The benefit held across nearly all patient subgroups, with only two exceptions: those with prior COPD hospitalizations and those with high eosinophil counts (>300 cells/μL).
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Why it matters: Roflumilast is notorious for GI side effects that drive patients to quit, and many non-specialist prescribers are more comfortable with azithromycin. However, long-term macrolide use carries its own risks — including hearing loss and QT prolongation — so monitoring remains essential. The upcoming RELIANCE randomized trial will provide further clarity.
