RT Journal Article
SR Electronic
T1 A new user cohort study comparing the risk of pneumonia in inhaled corticosteroid (ICS) vs. long-acting bronchodilator (LABD) regimens in COPD
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P4723
VO 42
IS Suppl 57
A1 Rachael DiSantostefano
A1 Tim Sampson
A1 Hoa Van Le
A1 Kourtney Davis
A1 Nawar Bakerly
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/P4723.abstract
AB Aims: To estimate the association between ICS use and outcomes of overall pneumonia and pneumonia hospitalization in new users of ICS relative to new users of inhaled LABD monotherapy.Methods: Pneumonia and pneumonia hospitalization events in COPD patients ≥45 years old were compared in new users of ICS medications (n=11,555; ICS, ICS/LABA combination) and inhaled LABD monotherapies (n=6,492; LABA, LAMA) using Cox models (hazard ratios [HR] and 95% confidence intervals [CI]), with propensity scores to control for confounding. Setting: United Kingdom electronic medical records with linked hospitalization and mortality data (2002-2010). New users were censored at earliest of: pneumonia event, death, switching/stopping treatment, or end of study period. Outcomes: time to first pneumonia (any), pneumonia hospitalization (primary cause).Results: New use of ICS-containing mediations was associated with an increased risk of pneumonia (n=18,047 at risk, n=702 events; HR=1.49, 95% CI: 1.22, 1.83) and pneumonia hospitalization (n=18,047, n=409 events; HR=1.52 95% CI: 1.16, 1.98). Excess ICS risk was reduced when requiring ≥30 days of new use (n=17,287, n=614 events; HR=1.39, 95% CI: 1.12, 1.72) or persistent use (≥6 months; n= 9,396; n=507 events, HR=1.19, 95% CI: 0.93, 1.52).Conclusions: The results of this new-user study design are consistent with published findings that ICS increase risk of pneumonia and hospitalized pneumonia in COPD. This risk must be weighed against the benefits when prescribing ICS to patients with COPD.(GSK-funded, WEUSKOP6416).