ICS use for COPD treatment increases incidence of pneumonia, reduces mortality risk

DENVER — Inhaled corticosteroids put patients with COPD at an increased risk for incident pneumonia, however there appears to be a counterbalancing beneficial effect on pneumonia-associated mortality, according to study results presented at the American Thoracic Society International Conference.

“What we found was, when looking at the outcome of pneumonia in randomized control trials, the [trials] showed a significantly increased risk of incident pneumonia,” Ena Gupta, MD, MPH, internal medicine resident at the University of Florida Jacksonville Healthcare Inc., told Healio.com/Pulmonology. “Almost a 60% increase [as well as in] the observational studies which has been long shown in a lot of studies before [our] meta-analysis that inhaled corticosteroids have an increased risk of pneumonia associated with them in COPD patients. But, what was interesting was when we looked at pneumonia-associated mortality and all-cause mortality, you would expect that since pneumonia is a cause of mortality in COPD patients, you would expect the people who have more COPD would be higher, but the findings were a little bit different.”

Gupta and colleagues conducted a systematic review and meta-analysis of 38 studies obtained from articles in PubMed, Medline, Central, Embase, Scopus, Web of Science and manufacturers’ Web clinical trial registries from 1994 to February 2014 to confirm the increased risk for pneumonia and to determine whether inhaled corticosteroid use impacted pneumonia-associated and overall mortality.

The estimated unadjusted risk for pneumonia increased in both the randomized (n = 29) (RR = 1.61; 95% CI, 1.35-1.93) and in the observational studies (OR = 1.89; 95% CI, 1.39-2.59).

Six randomized trials showed no difference in pneumonia-associated mortality (RR = 0.91; 95% CI, 0.52-1.59) and seven observational studies actually showed a decrease in pneumonia-associated mortality (OR = 0.72; 95% CI, 0.59-0.88).

All the randomized trials estimated no difference in unadjusted risk for mortality in patients with COPD who used ICS treatment (RR = 0.95; 95% CI, 0.85-1.05). Six of the observational studies indicated a decrease in overall mortality (OR = 0.79; 95% CI, 0.65-0.97).

Gupta told Healio.com/Pulmonology more randomized control trials are needed in the future.

“What would be really helpful is a head-to-head trial with comparing outcomes of pneumonia in these groups,” she said. “Something more that’s a prospective randomized control trial studying the outcomes of pneumonia in both these groups.” – by Ryan McDonald

Reference:

Gupta E, et al. Poster 547. Presented at: American Thoracic Society International Conference; May 15-20, 2015; Denver.

Disclosure: Gupta reports no relevant financial disclosures.