Inhaled corticosteroids produce mixed results for COPD patients

Issue: June 2015

Inhaled corticosteroids increased the incidence of pneumonia but reduced the risk for pneumonia-associated and overall mortality in patients with chronic obstructive pulmonary disease, according to the results of a recent systematic review and meta-analysis presented at the American Thoracic Society International Conference in Denver.

“Inhaled corticosteroids are currently recommended for use in patients with severe [chronic obstructive pulmonary disease (COPD)] and those with frequent exacerbations,” Ena Gupta, MD, MPH, of the University of Florida College of Medicine, and colleagues wrote. “The TORCH study and several other trials have shown increased incidence of pneumonia among patients using [inhaled corticosteroids (ICS)]. This meta-analysis was done to affirm the increased risk of pneumonia and then better define whether ICS use affected unadjusted pneumonia-associated and overall mortality.”

Gupta and colleagues examined 38 studies conducted between 1994 and 2014, including 29 randomized controlled trials and nine observational studies of inhaled corticosteroids in COPD patients.

Study results showed that the estimated unadjusted pneumonia risk for patients using ICS increased in randomized trials (RR = 1.61; 95% CI, 1.35-1.93) and observational studies (OR = 1.89; 95% CI, 1.39-2.59). However, incidence of pneumonia-related mortality was similar in randomized trials (RR = 0.91; 95% CI, 0.52-1.59), and the risk decreased in observational studies (OR = 0.72; 95% CI, 0.59-0.88).

In addition, the researchers found no difference in the unadjusted risk for overall mortality in randomized trials (RR = 0.95; 95% CI, 0.85-1.05), and observational studies demonstrated a decrease in overall mortality in the ICS group (OR = 0.79; 95% CI, 0.65-0.97).

“Our systematic review … echoes previous studies which have shown that while ICS use increases the risk of pneumonia in COPD patients, we found no significant difference between pneumonia-associated and overall mortality in the ICS and non-ICS groups in randomized trials. In fact, observational studies showed significantly decreased risk of pneumonia-associated and overall mortality between the two groups,” Gupta told Infectious Disease News. “This double effect may be due to the immunosuppressive and anti-inflammatory effects of ICS treatment. This data can be used to weigh the overall risks and benefits of ICS use in COPD patients.” – by David Jwanier

Reference:
Gupta E, et al. Abstract 63126. Presented at: American Thoracic Society International Conference; May 15-20, 2015; Denver.

Disclosure: The researchers report no relevant financial disclosures.