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Use of Inhaled Corticosteroids in Patients With COPD and the Risk of TB and Influenza A Systematic Review and Meta-analysis of Randomized Controlled Trials

Dong, Yaa-Hui; Chang, Chia-Hsuin; Wu, Fe-Lin Lin; Shen, Li-Jiuan; Calverley, Peter M. A.; Löfdahl, Claes-Göran LU ; Lai, Mei-Shu and Mahler, Donald A. (2014) In Chest 145(6). p.1286-1297
Abstract
Background: The use of inhaled corticosteroids (ICSs) is associated with an increased risk of pneumonia in patients with COPD. However the risks of other respiratory infections such as TB and influenza remain unclear. Methods: Through a comprehensive literature search of MEDLINE EMBASE CINAHL Cochrane Library and ClinicalTrials.gov from inception to July 2013 we identified randomized controlled trials of ICS therapy lasting at least 6 months. We conducted meta-analyses by the Peto Mantel-Haenszel and Bayesian approaches to generate summary estimates comparing ICS with non-ICS treatment on the risk of TB and influenza. Results: Twenty-five trials (22,898 subjects) for TB and 26 trials (23,616 subjects) for influenza were included. Compared... (More)
Background: The use of inhaled corticosteroids (ICSs) is associated with an increased risk of pneumonia in patients with COPD. However the risks of other respiratory infections such as TB and influenza remain unclear. Methods: Through a comprehensive literature search of MEDLINE EMBASE CINAHL Cochrane Library and ClinicalTrials.gov from inception to July 2013 we identified randomized controlled trials of ICS therapy lasting at least 6 months. We conducted meta-analyses by the Peto Mantel-Haenszel and Bayesian approaches to generate summary estimates comparing ICS with non-ICS treatment on the risk of TB and influenza. Results: Twenty-five trials (22,898 subjects) for TB and 26 trials (23,616 subjects) for influenza were included. Compared with non-ICS treatment ICS treatment was associated with a significantly higher risk of TB (Peto OR 2.29 95% CI 1.04-5.03) but not influenza (Peto OR 1.24 95% CI 0.94-1.63). Results were similar with each meta-analytic approach. Furthermore the number needed to harm to cause one additional TB event was lower for patients with COPD treated with ICSs in endemic areas than for those in nonendemic areas (909 vs 1,667 respectively). Conclusions: This study raises safety concerns about the risk of TB and influenza associated with ICS use in patients with COPD which deserve further investigation. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Chest
volume
145
issue
6
pages
1286 - 1297
publisher
American College of Chest Physicians
external identifiers
  • wos:000337355600022
  • scopus:84901838031
ISSN
1931-3543
DOI
10.1378/chest.13-2137
language
English
LU publication?
yes
id
f923443f-001e-4e5b-ab47-cbd3919a8472 (old id 4609626)
date added to LUP
2014-09-01 07:44:57
date last changed
2017-11-05 03:55:59
@article{f923443f-001e-4e5b-ab47-cbd3919a8472,
  abstract     = {Background: The use of inhaled corticosteroids (ICSs) is associated with an increased risk of pneumonia in patients with COPD. However the risks of other respiratory infections such as TB and influenza remain unclear. Methods: Through a comprehensive literature search of MEDLINE EMBASE CINAHL Cochrane Library and ClinicalTrials.gov from inception to July 2013 we identified randomized controlled trials of ICS therapy lasting at least 6 months. We conducted meta-analyses by the Peto Mantel-Haenszel and Bayesian approaches to generate summary estimates comparing ICS with non-ICS treatment on the risk of TB and influenza. Results: Twenty-five trials (22,898 subjects) for TB and 26 trials (23,616 subjects) for influenza were included. Compared with non-ICS treatment ICS treatment was associated with a significantly higher risk of TB (Peto OR 2.29 95% CI 1.04-5.03) but not influenza (Peto OR 1.24 95% CI 0.94-1.63). Results were similar with each meta-analytic approach. Furthermore the number needed to harm to cause one additional TB event was lower for patients with COPD treated with ICSs in endemic areas than for those in nonendemic areas (909 vs 1,667 respectively). Conclusions: This study raises safety concerns about the risk of TB and influenza associated with ICS use in patients with COPD which deserve further investigation.},
  author       = {Dong, Yaa-Hui and Chang, Chia-Hsuin and Wu, Fe-Lin Lin and Shen, Li-Jiuan and Calverley, Peter M. A. and Löfdahl, Claes-Göran and Lai, Mei-Shu and Mahler, Donald A.},
  issn         = {1931-3543},
  language     = {eng},
  number       = {6},
  pages        = {1286--1297},
  publisher    = {American College of Chest Physicians},
  series       = {Chest},
  title        = {Use of Inhaled Corticosteroids in Patients With COPD and the Risk of TB and Influenza A Systematic Review and Meta-analysis of Randomized Controlled Trials},
  url          = {http://dx.doi.org/10.1378/chest.13-2137},
  volume       = {145},
  year         = {2014},
}