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Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids : Effect of drug, dose, and device

Dekhuijzen, P. N Richard; Batsiou, Maria; Bjermer, Leif LU ; Bosnic-Anticevich, Sinthia; Chrystyn, Henry; Papi, Alberto; Rodríguez-Roisin, Roberto; Fletcher, Monica; Wood, Lucy and Cifra, Alessandra LU , et al. (2016) In Respiratory Medicine 120. p.54-63
Abstract

Background and aims Little information is available on real-life occurrence of oral thrush in COPD patients treated with ICS. We investigated oral thrush incidence in COPD patients prescribed FDC ICS/LABA therapies and assessed whether it is modulated by the ICS type, dose, and delivery device. Methods We conducted a historical, observational, matched cohort study (one baseline year before and one outcome year after initiation of therapy) using data from the UK Optimum Patient Care Research Database. We assessed oral thrush incidence in patients initiating long-acting bronchodilators or FDC ICS/LABA therapy. We then compared different combination therapies (budesonide/formoterol fumarate dihydrate [BUD/FOR] and fluticasone... (More)

Background and aims Little information is available on real-life occurrence of oral thrush in COPD patients treated with ICS. We investigated oral thrush incidence in COPD patients prescribed FDC ICS/LABA therapies and assessed whether it is modulated by the ICS type, dose, and delivery device. Methods We conducted a historical, observational, matched cohort study (one baseline year before and one outcome year after initiation of therapy) using data from the UK Optimum Patient Care Research Database. We assessed oral thrush incidence in patients initiating long-acting bronchodilators or FDC ICS/LABA therapy. We then compared different combination therapies (budesonide/formoterol fumarate dihydrate [BUD/FOR] and fluticasone propionate/salmeterol xinafoate [FP/SAL]) and devices (DPI and pMDI). Results Patients prescribed FDC ICS/LABA had significantly greater odds of experiencing oral thrush than those prescribed long-acting bronchodilators alone (adjusted OR 2.18 [95% CI 1.84–2.59]). Significantly fewer patients prescribed BUD/FOR DPI developed oral thrush compared with FP/SAL DPI (OR 0.77 [0.63–0.94]) when allowing for differences in prescribed doses between the drugs. A significantly smaller proportion of patients developed oral thrush in the FP/SAL pMDI arm than in the FP/SAL DPI arm (OR 0.67 [0.55–0.82]). Additionally, in the FP/SAL cohort (both DPI and pMDI), increased risk of oral thrush was significantly associated with high ICS daily dose (OR 1.97 [1.22–3.17] vs low daily dose). Conclusions ICS use increases oral thrush incidence in COPD and this effect is dose-dependent for FP/SAL therapies. Of the therapies assessed, FP/SAL pMDI and BUD/FOR DPI may be more protective against oral thrush.

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published
subject
keywords
Chronic obstructive pulmonary disease, Dry powder inhaler, Inhaled corticosteroid, Oral candidiasis, Pressurised metered-dose inhaler, Spacer
in
Respiratory Medicine
volume
120
pages
10 pages
publisher
Elsevier
external identifiers
  • scopus:84990895456
  • wos:000388116100008
ISSN
0954-6111
DOI
10.1016/j.rmed.2016.09.015
language
English
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yes
id
d1a334de-b5d1-4b63-a150-44026f9f88c6
date added to LUP
2016-10-31 08:56:38
date last changed
2017-11-14 09:56:18
@article{d1a334de-b5d1-4b63-a150-44026f9f88c6,
  abstract     = {<p>Background and aims Little information is available on real-life occurrence of oral thrush in COPD patients treated with ICS. We investigated oral thrush incidence in COPD patients prescribed FDC ICS/LABA therapies and assessed whether it is modulated by the ICS type, dose, and delivery device. Methods We conducted a historical, observational, matched cohort study (one baseline year before and one outcome year after initiation of therapy) using data from the UK Optimum Patient Care Research Database. We assessed oral thrush incidence in patients initiating long-acting bronchodilators or FDC ICS/LABA therapy. We then compared different combination therapies (budesonide/formoterol fumarate dihydrate [BUD/FOR] and fluticasone propionate/salmeterol xinafoate [FP/SAL]) and devices (DPI and pMDI). Results Patients prescribed FDC ICS/LABA had significantly greater odds of experiencing oral thrush than those prescribed long-acting bronchodilators alone (adjusted OR 2.18 [95% CI 1.84–2.59]). Significantly fewer patients prescribed BUD/FOR DPI developed oral thrush compared with FP/SAL DPI (OR 0.77 [0.63–0.94]) when allowing for differences in prescribed doses between the drugs. A significantly smaller proportion of patients developed oral thrush in the FP/SAL pMDI arm than in the FP/SAL DPI arm (OR 0.67 [0.55–0.82]). Additionally, in the FP/SAL cohort (both DPI and pMDI), increased risk of oral thrush was significantly associated with high ICS daily dose (OR 1.97 [1.22–3.17] vs low daily dose). Conclusions ICS use increases oral thrush incidence in COPD and this effect is dose-dependent for FP/SAL therapies. Of the therapies assessed, FP/SAL pMDI and BUD/FOR DPI may be more protective against oral thrush.</p>},
  author       = {Dekhuijzen, P. N Richard and Batsiou, Maria and Bjermer, Leif and Bosnic-Anticevich, Sinthia and Chrystyn, Henry and Papi, Alberto and Rodríguez-Roisin, Roberto and Fletcher, Monica and Wood, Lucy and Cifra, Alessandra and Soriano, Joan B. and Price, David B.},
  issn         = {0954-6111},
  keyword      = {Chronic obstructive pulmonary disease,Dry powder inhaler,Inhaled corticosteroid,Oral candidiasis,Pressurised metered-dose inhaler,Spacer},
  language     = {eng},
  month        = {11},
  pages        = {54--63},
  publisher    = {Elsevier},
  series       = {Respiratory Medicine},
  title        = {Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids : Effect of drug, dose, and device},
  url          = {http://dx.doi.org/10.1016/j.rmed.2016.09.015},
  volume       = {120},
  year         = {2016},
}