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Chest. 2014 Feb 6. doi: 10.1378/chest.13-2137. [Epub ahead of print]
Use of Inhaled Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease and the Risk of Tuberculosis and Influenza: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Dong YH, Chang CH, Wu FL, Shen LJ, Calverley PM, L?fdahl CG, Lai MS, Mahler DA.
Abstract
ABSTRACT BACKGROUND:
The use of inhaled corticosteroids (ICS) is associated with an increased risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). However, the risks on other respiratory infections such as tuberculosis and influenza remained unclear.
METHODS:
By comprehensive literature searching of MEDLINE, EMBASE, CINAHL, Cochrane Library, and ClinicalTrials.gov from inception to July 2013, we identified randomized controlled trials of ICS lasting at least six months. We conducted meta-analyses by the Peto, Mantel-Haenszel, and Bayesian approaches to generate summary estimates comparing ICS treatment versus non-ICS treatment for the risk of tuberculosis and influenza.
RESULTS:
Twenty-five trials (22,898 subjects) for tuberculosis and 26 trials (23,616 subjects) for influenza were included. ICS treatment was associated with a significantly higher risk of tuberculosis (Peto OR, 2.29; 95% CI, 1.04-5.03) but was not associated with a significantly increased risk of influenza (Peto OR, 1.24; 95% CI, 0.94-1.63) versus non-ICS treatment. Results were similar with each meta-analytic approach. Furthermore, the number needed-to-harm (NNH) to cause one additional tuberculosis event was lower for patients in endemic areas (NNH=909), as compared with those in non-endemic areas (NNH=1,667), if treating COPD patients by ICS.
CONCLUSIONS:
Our study raises the safety concerns about the risk of tuberculosis and influenza associated with ICS use in COPD patients which deserve further investigation.
PMID:
24504044
[PubMed - as supplied by publisher]
Use of Inhaled Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease and the Risk of Tuberculosis and Influenza: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Dong YH, Chang CH, Wu FL, Shen LJ, Calverley PM, L?fdahl CG, Lai MS, Mahler DA.
Abstract
ABSTRACT BACKGROUND:
The use of inhaled corticosteroids (ICS) is associated with an increased risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). However, the risks on other respiratory infections such as tuberculosis and influenza remained unclear.
METHODS:
By comprehensive literature searching of MEDLINE, EMBASE, CINAHL, Cochrane Library, and ClinicalTrials.gov from inception to July 2013, we identified randomized controlled trials of ICS lasting at least six months. We conducted meta-analyses by the Peto, Mantel-Haenszel, and Bayesian approaches to generate summary estimates comparing ICS treatment versus non-ICS treatment for the risk of tuberculosis and influenza.
RESULTS:
Twenty-five trials (22,898 subjects) for tuberculosis and 26 trials (23,616 subjects) for influenza were included. ICS treatment was associated with a significantly higher risk of tuberculosis (Peto OR, 2.29; 95% CI, 1.04-5.03) but was not associated with a significantly increased risk of influenza (Peto OR, 1.24; 95% CI, 0.94-1.63) versus non-ICS treatment. Results were similar with each meta-analytic approach. Furthermore, the number needed-to-harm (NNH) to cause one additional tuberculosis event was lower for patients in endemic areas (NNH=909), as compared with those in non-endemic areas (NNH=1,667), if treating COPD patients by ICS.
CONCLUSIONS:
Our study raises the safety concerns about the risk of tuberculosis and influenza associated with ICS use in COPD patients which deserve further investigation.
PMID:
24504044
[PubMed - as supplied by publisher]
