New research published in JAMA Ophthalmology suggests that, when taken for severe meibomian gland dysfunction (MGD) treatment, oral azithromycin is a comparable alternative to doxycycline.
Give me some background on these drugs.
Doxycycline is a tetracycline antibiotic with both anti-microbial and anti-inflammatory properties. Used as an adjunctive therapy for MGD, eyecare professionals (ECPs) can prescribe it in low (20 mg BID) and high (200 mg/day) doses.
Azithromycin is a macrolide antibiotic used to treat certain bacterial infections. When taken orally, a single dose can range from 500 to 2,000 mg/day.
Now talk about the study.
Researchers conducted a double-masked, randomized trial of 137 patients (137 eyes) with moderate-to-severe MGD. Patients were randomly given either 1 g azithromycin once a week for 3 weeks (68 patients/eyes), or 200 mg doxycycline daily for 6 weeks (69 patients/eyes).
Investigators assessed the total MGD score and Ocular Surface Disease Index (OSDI) score at the initial visit, 6 weeks, and 8 weeks. Prespecified equivalence margins were set at ±2 for the MGD score and ±9 for the OSDI score.
So what did they find?
The adjusted mean between-group difference for MGD scores was -0.33 (Week 6) and 0.13 (Week 8). For the OSDI score, the adjusted mean difference was -1.20 (Week 6) and -1.59 (Week 8).
Any adverse effects?
Doxycycline-treated patients reported more gastrointestinal adverse effects (15.9%) than azithromycin patients (4.4%).
Takeaway.
According to study authors, 3 weeks of azithromycin dosing can be considered an equivalent alternative to 6 weeks of doxycycline for moderate-to-severe MGD.
However, they stated that, “Longer-term follow-up in each group would be needed to determine if these outcomes persist for this chronic condition.”