COPD: doxycycline add-on reduces short-term acute exacerbation risk in elderly

  • Wang Y & al.
  • BMJ Open Respir Res
  • 1 Feb 2020

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • In older patients with COPD, doxycycline added on to corticosteroid reduces treatment failure (acute exacerbation; AECOPD) by 23% in the short term (15-31 days of initiation).
  • However, no reductions were seen in this population in the long term (approximately 12 months) or in all-ages analyses.

Why this matters

  • This analysis is the first for doxycycline add-on for AECOPD using real-world evidence.

Study design

  • A retrospective cohort study of pharmacy claims for 6300 adult primary care outpatients in the Netherlands who received either doxycycline (n=2261) or no antibiotic (n=4039) added on to corticosteroid (40 mg daily for 5 days or 30 mg daily for 7 days).
  • Primary outcome: treatment failure, AECOPD in the short- and long-term.
  • Funding: University of Groningen.

Key results

  • No difference between doxycycline and no-antibiotic groups in short-term risk for treatment failure across all age groups combined.
  • However, an older subgroup (aged 75+ years) had a 23% reduced risk for treatment failure with add-on doxycycline:
    • 16.1% vs 19.9% in no-antibiotic group.
    • Adjusted OR, 0.77 (95% CI, 0.62-0.97).
  • Groups did not differ in long-term risk (median time to next exacerbation), regardless of age.

Limitations

  • Retrospective, observational design.
  • Reliance on pharmacy claims data.