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However, there is little published evidence for effectiveness in patients treated with biologics. We conducted a retrospective audit of all patients who started azithromycin while on biologics in our centre. Compared with those that did not start azithromycin, these individuals had more exacerbations and a phenotype of chronic bronchitis and\/or frequent purulent exacerbations. The addition of azithromycin to biologics was associated with reduced annual rates of steroid-treated and antibiotic-treated exacerbations and improved symptom scores (Asthma Control Questionnaire-5) but not with any improvement in lung function. Data support testing azithromycin in clinical trials in patients on biologics with residual exacerbations.<\/jats:p>","DOI":"10.1136\/thorax-2024-221977","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T13:10:18Z","timestamp":1737119418000},"page":"113-116","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Effects of azithromycin in severe eosinophilic asthma with concomitant monoclonal antibody treatment"],"prefix":"10.1136","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0280-0825","authenticated-orcid":false,"given":"Gabriel","family":"Lavoie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6033-0488","authenticated-orcid":false,"given":"Imran","family":"Howell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3977-7012","authenticated-orcid":false,"given":"James","family":"Melhorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Borg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Bermejo-Sanchez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Seymour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1887-596X","authenticated-orcid":false,"given":"Maisha F.","family":"Jabeen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Fries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth","family":"Hynes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4288-5973","authenticated-orcid":false,"given":"Ian D","family":"Pavord","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayia","family":"Petousi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy SC","family":"Hinks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,12,18]]},"reference":[{"key":"2025011705101010000_80.2.113.1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(21)00004-7"},{"key":"2025011705101010000_80.2.113.2","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2012-202698"},{"key":"2025011705101010000_80.2.113.3","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/S0140-6736(17)31281-3","article-title":"Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trial","volume":"390","author":"Gibson","year":"2017","journal-title":"The Lancet"},{"key":"2025011705101010000_80.2.113.4","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00528-2020"},{"key":"2025011705101010000_80.2.113.5","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2019-213929"},{"key":"2025011705101010000_80.2.113.6","unstructured":"MFaS J , Nicholas D , Tin\u00e8 M , et al . Species-level, metagenomic and proteomic analysis of microbe-immune interactions in severe asthma. 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