Study Examines Efficacy of Add-On Antibiotic for COPD Exacerbations

Adding doxycycline for the treatment of chronic obstructive pulmonary disease (COPD) exacerbations does not prolong the time between exacerbations, according to the findings of a new study.

The randomized, double-blind, placebo-controlled trial included 305 patients with moderate-to-severe COPD who had at least one exacerbation during the past 3 years and was being treated at outpatient clinics in the Netherlands. After an exacerbation, 152 participants were randomly assigned to receive 100 mg daily oral dose of doxycycline for 7 days and 151 participants were assigned to receive an identical placebo course. All participants received a 30 mg 10-day course of oral prednisolone. The time to next exacerbation was measured as the primary outcome, and participants were followed for 2 years.
_______________________________________________________________________________________________________________________________________________
RELATED CONTENT
Study Questions Long-Term Supplemental Oxygen for COPD Patients
Differentiating COPD Exacerbations From Other Conditions
Study Questions Trends in COPD Exacerbation Frequency
_______________________________________________________________________________________________________________________________________________

Four patients were excluded from the analysis after being incorrectly randomly allocated. Of the 301 patients included in the final analysis, 257 (85%) patients had another exacerbation following treatment, of which 131 (87%) were in the doxycycline group and 126 (83%) were in the placebo group.

The median time to next exacerbation was 148 days in the doxycycline group compared with 161 days for patients in the placebo group.

In addition, researchers did not observe any significant differences between groups in the frequency of adverse events in the first 2 weeks after patients were randomized, and no differences in serious adverse events during follow-up.

“In patients with mild-to-severe COPD receiving treatment for an exacerbation in an outpatient setting, the antibiotic doxycycline added to the oral corticosteroid prednisolone did not prolong time to next exacerbation compared with prednisolone alone,” the researchers concluded. “These findings do not support prescription of antibiotics for COPD exacerbations in an outpatient setting.”

—Melissa Weiss

Reference:

van Velzen P, ter Riet G, Bresser P, et al. Doxycycline for outpatient-treated acute exacerbations of COPD: a randomised double-blind placebo-controlled trial [published online May 5, 2017]. Lancet Respir Med. dx.doi.org/10.1016/S2213-2600(17)30165-0.