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
(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)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/4609626
- author
- 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.
- organization
- publishing date
- 2014
- 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
- 2016-04-01 13:20:15
- date last changed
- 2022-03-21 18:01:59
@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}}, doi = {{10.1378/chest.13-2137}}, volume = {{145}}, year = {{2014}}, }