Risk of Mortality and Cardiovascular Events in Patients with Chronic Obstructive Pulmonary Disease Treated with Azithromycin, Roxithromycin, Clarithromycin, and Amoxicillin

<b>Background:</b> Prior research has raised concerns regarding the use of macrolides and their association with an increased risk of cardiovascular events. <b>Methods:</b> We conducted a cohort study, where we explored the cardiovascular risks associated with the treatment o...

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Bibliographic Details
Main Authors: Imane Achir Alispahic, Josefin Eklöf, Pradeesh Sivapalan, Alexander Ryder Jordan, Zitta Barrella Harboe, Tor Biering-Sørensen, Jens-Ulrik Stæhr Jensen
Format: Article
Language:English
Published: MDPI AG 2024-03-01
Series:Journal of Clinical Medicine
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Online Access:https://www.mdpi.com/2077-0383/13/7/1987
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Summary:<b>Background:</b> Prior research has raised concerns regarding the use of macrolides and their association with an increased risk of cardiovascular events. <b>Methods:</b> We conducted a cohort study, where we explored the cardiovascular risks associated with the treatment of COPD patients using macrolide antibiotics–namely azithromycin, clarithromycin, and roxithromycin—with amoxicillin serving as a reference. The study focused on COPD patients in an outpatient setting and included a thorough 3-year follow-up. Patients were categorized into four groups based on their treatment. The primary analysis utilized an adjusted Cox model, supplemented by sensitivity analysis through inverse probability of treatment weighting. <b>Results:</b> No significant differences were found in major adverse cardiovascular events (MACE—stroke, acute myocardial infarction, cardiovascular death) between the macrolide groups, and the amoxicillin/hazard ratios (HR) were azithromycin HR = 1.01, clarithromycin HR = 0.99, and roxithromycin HR = 1.02. Similarly, sensitivity analysis showed no disparities in all-cause mortality and cardiovascular death among the groups. <b>Conclusions:</b> Overall, the study revealed no evidence of increased risk of MACE, all-cause mortality, or cardiovascular death in COPD patients treated with these macrolides compared to amoxicillin over a 3-year period.
ISSN:2077-0383