ArticleChronic obstructive pulmonary diseases (Miami, Fla.)2021
Comparative Effectiveness of Roflumilast and Azithromycin for the Treatment of Chronic Obstructive Pulmonary Disease.
Article in Chronic obstructive pulmonary diseases (Miami, Fla.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
6 citing papers in PubMed.
- Mechanisms, Efficacy, Safety, and Pharmacoeconomics of Low-Dose, Long-Term Macrolide Antibiotics in the Treatment of Chronic Obstructive Pulmonary Disease: A Review.International journal of chronic obstructive pulmonary disease · 2026Review
- Long-Term Macrolides in Chronic Respiratory Diseases: Dusk or a New Dawn? A Narrative Review.Antibiotics (Basel, Switzerland) · 2025Review
- Clinical and Economic Burden of COPD in Patients on Inhaled Triple Therapy in Germany - A Retrospective Claims Data Analysis.International journal of chronic obstructive pulmonary disease · 2025Article
- Waiting for Actionable Evidence: Roflumilast or Azithromycin?Chronic obstructive pulmonary diseases (Miami, Fla.) · 2022Article
- Improving Physiological, Physical, and Psychological Health Outcomes: A Narrative Review in US Veterans with COPD.International journal of chronic obstructive pulmonary disease · 2022Review
- Dysfunction in the Cystic Fibrosis Transmembrane Regulator in Chronic Obstructive Pulmonary Disease as a Potential Target for Personalised Medicine.Biomedicines · 2021Review
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
backgroundIn chronic obstructive pulmonary disease (COPD) patients with exacerbations despite optimized bronchodilator therapy, roflumilast and chronic azithromycin are recommended options. Roflumilast is recommended in severe COPD patients with chronic bronchitis, whereas chronic azithromycin is more broadly indicated. The comparative effectiveness between these 2 treatments to reduce exacerbation rate remains unclear.
objectivesOur objective was analysis of the Veterans Health Administration (VHA) database (medication and claims data without lung function or presence of chronic bronchitis or tobacco use) to compare the effectiveness of roflumilast and azithromycin on hospitalizations and mortality.
methodsThe primary outcome of the study was cumulative incidences of first COPD-related and all-cause hospitalization. Sensitivity analysis on hospitalizations was conducted for VHA patients who also had Medicare.
resultsIn 1302 roflumilast and 2573 azithromycin patients, the all-cause mortality rates at 1 year were 19% and 15%, respectively. The median times-to-all-cause death were 47 months (interquartile range [IQR] 16-81) for the roflumilast and 48 months (IQR 20-83) for the azithromycin groups. Roflumilast was associated with higher mortality (hazard ratio [HR] 1.16; 95% confidence interval [CI], 1.04-1.29). Roflumilast showed no significant association for COPD-related hospitalization (subdistribution HR [SHR]=1.14, 95% CI, 1.00-1.29) and all-cause hospitalization (HR 1.07, 95% CI, 0.97-1.18). For patients with Medicare (N=2030), roflumilast was associated with higher COPD-related (SHR 1.21; 95% CI, 1.05-1.41) and all-cause (SHR 1.23; 95% CI, 1.09-1.38) hospitalizations.
conclusionsRoflumilast was associated with higher hazard ratios for death, COPD-related hospitalizations, and all-cause hospitalizations in COPD patients only after adjustment for VHA and external Medicare events. Prospective clinical trials are needed to directly compare the relative efficacy of these therapies.
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