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  • Azithromycin Versus Doxycycline for MGD

    By Lynda Seminara
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, May 2023

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    The typical medical management for moderate or severe meibomian gland dysfunction (MGD) is a six-week course of doxycycline, which often causes adverse events (AEs) that hinder com­pliance. Although azithromycin has been explored as a treatment option for MGD, study designs have been limited. It is plausible that oral azith­romycin, dosed at 1 gram weekly for three weeks, may result in adequate tissue levels of medication for at least one month—perhaps leading to better patient compliance than is possible with drugs that require daily dosing. In a double-masked, randomized controlled trial, Upaphong et al. compared this regimen of azithromycin with daily doxycycline dosing for six weeks and found comparable efficacy. Gastrointestinal AEs were less common with azithromycin.

    The trial occurred at an ophthal­mology referral center in Thailand and included patients with moderate or severe MGD that did not respond to conservative therapy. The partic­ipants were assigned randomly to receive oral azithromycin (1 g weekly for three weeks) or oral doxycycline (200 mg daily for six weeks). MGD score and ocular surface disease index (OSDI) were documented at the initial study visit (treatment inception), as well as six and eight weeks later. The prespecified equivalence margins for MGD score and OSDI were ±2 and ±9, respectively. To evaluate safety, AEs were recorded at weeks 6 and 8.

    All told, 137 eyes (137 patients) underwent randomization: 68 received azithromycin, and 69 received doxycy­cline. The adjusted mean difference in total MGD score between the groups was −0.33 at six weeks (95% CI, −1.70- 1.03; p for equivalence = .01) and 0.13 at eight weeks (95% CI, −1.59-1.84; p for equivalence = .02). The adjusted mean difference in OSDI between the groups was −1.20 at six weeks (95% CI, −5.31-2.91; p for equivalence < .001) and −1.59 at eight weeks (95% CI, −5.73-2.55; p for equivalence < .001). The rate of gastrointestinal AEs was lower for azithromycin (4.4% vs. 15.9%; risk difference, 11.5%; 95% CI, 1.6%- 21.4%; p = .03).

    The investigators concluded that “the reduced dosing and potentially fewer gastrointestinal AEs associated with azithromycin support its use as an alternative to doxycycline for at least six weeks” in the management of moderate or severe MGD. They noted that longer follow-up of both study groups would be required to determine if efficacy and safety will be sustained. (Also see related commentary by B. Michele Melia, ScM, in the same issue.)

    The original article can be found here.