Troleandomycin as an oral corticosteroid sparing agent in stable asthma

Troleandomycin is a macrolide antibiotic with established effects in the treatment of infections. It alters the breakdown of corticosteroid drugs, so may be of benefit in asthma. This review found three small studies, that provide no evidence to justify the use of this drug in asthma.

Authors' conclusions: 

There is insufficient evidence to support the use of troleandomycin in the treatment of steroid dependent asthma.

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Background: 

Patients with chronic severe asthma are often dependent on the long term prescription of oral corticosteroids. The use of steroids is associated with serious side effects. Physicians treating such patients continue to search for alternative therapies that reduce the need for chronic dosing with oral steroids. Troleandomycin is a compound that is established as an effective antibiotic but may also have non-antibacterial actions that may be useful in the treatment of asthma.

Objectives: 

The objective of this review was to assess the effects of adding troleandomycin to oral steroids in the treatment of chronic steroid dependent asthmatics.

Search strategy: 

The Cochrane Airways Group Specialised Register and reference lists of identified articles were searched. Searches are current as of September 2010.

Selection criteria: 

Randomised trials looking at the addition of troleandomycin compared to placebo in adult steroid dependent asthmatics.

Data collection and analysis: 

Trial quality was assessed and data extraction was carried out by two reviewers independently. Study authors were contacted for missing information.

Main results: 

Three trials fulfilled the criteria for inclusion in the review and a total of 112 patients were recruited into these studies. Data from 90 patients were analysed. There was no treatment effect for troleandomycin in terms of steroid dose reduction (SMD -0.29, 95% CI -0.75, 0.17). For measures of lung function a meta-analysis of data derived from two of the included studies showed no benefits for added troleandomycin (SMD 0.06 95% CI -0.8, 0.9).

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