Details

Autor(en) / Beteiligte

• Price, David
• Henley, William
• Cancado, Jose Eduardo Delfini
• Fabbri, Leonardo M
• Kerstjens, Huib A.M
• Papi, Alberto
• Roche, Nicolas
• Sen, Elif
• Singh, Dave
• Vogelmeier, Claus F
• Nudo, Elena
• Carter, Victoria
• Skinner, Derek
• Vella, Rebecca
• Soriano, Joan B
• Kots, Maxim
• Georges, George

Titel

Risk of Pneumonia in Patients with COPD Initiating Fixed Dose Inhaled Corticosteroid Formulations Containing Extrafine Beclometasone Dipropionate versus Patients Initiating LABD Without ICS

Ist Teil von

• Pragmatic and observational research, 2024-01, Vol.15, p.1

Ort / Verlag

Dove Medical Press Limited

Erscheinungsjahr

2024

Link zum Volltext

Quelle

EZB Free E-Journals

Beschreibungen/Notizen

• Background: Combined ICS and long-acting bronchodilators (LABD) more effectively reduce COPD exacerbations than LABD therapy alone. Corticosteroid-related adverse effects, including pneumonia, limit ICS use. Previous data suggest this risk is lower for extrafine beclometasone (ef-BDP). We compared pneumonia risk among new users of fixed dose ICS/LABD formulations containing ef-BDP, versus patients initiating LABD without any ICS. Methods: A propensity-matched historical cohort study design used data from OPCRD. COPD patients with [greater than or equal to]1 year of continuous data who initiated LABD or ICS/LABD formulations containing ef-BDP were matched. Primary outcome was time to pneumonia event, as treated, using either sensitive (physician diagnosed) or specific (physician diagnosed and x-ray or hospital admission confirmed) definitions, with non-inferiority boundary of 15%. Results: 23,898 COPD patients were matched, who were 68[+ or -]11 years, 54.3% male and 56% current-smokers, while 43% were former-smokers. Initiation of ef-BDP/LABD was not associated with an increased risk of pneumonia versus LABD, for either a sensitive 0.89 (0.78-1.02), P = 0.08 or a specific 0.91 (0.78-1.05), P = 0.18 definition of pneumonia. The probability of remaining pneumonia free 1-year after ef-BDP/LABD was 98.4%, which was comparable to LABD at 97.7%, and was sustained up to 6 years of observation; non-inferiority criterion was met for both definitions. Initiation of ef-BDP/LABD was also associated with a reduced risk of developing LRTIs in the propensity matched cohort. Conclusion: Risk of pneumonia when using ICS for the management of COPD reported in several randomised controlled trials may not be relevant with ef-BDP in a diverse real-world clinical population. Keywords: inhaled corticosteroids, pneumonia, COPD, extrafine beclometasone, long-acting bronchodilators