Interclass Difference in Pneumonia Risk in COPD Patients Initiating Fixed Dose Inhaled Treatment Containing Extrafine Particle Beclometasone versus Fine Particle Fluticasone

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Price D. B., Henley W., Delfini Cancado J. E., Fabbri L. M., Kerstjens H. A. M., Papi A., ...Daha Fazla

INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, cilt.17, ss.355-370, 2022 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 17
  • Basım Tarihi: 2022
  • Doi Numarası: 10.2147/copd.s342357
  • Dergi Adı: INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Directory of Open Access Journals
  • Sayfa Sayıları: ss.355-370
  • Anahtar Kelimeler: inhaled corticosteroids, pneumonia, COPD, extrafine beclomethasone, fluticasone, OBSTRUCTIVE PULMONARY-DISEASE, TRIPLE THERAPY, PARALLEL-GROUP, DOUBLE-BLIND, COMBINATION THERAPY, EXACERBATIONS, CORTICOSTEROIDS, PHARMACODYNAMICS, PHARMACOKINETICS, PREVENTION
  • Ankara Üniversitesi Adresli: Evet

Özet

Background: Inhaled corticosteroids (ICS) afford therapeutic benefits in some COPD patients, but their widespread use is cautioned due to an increased risk of developing pneumonia. Subclass variations exist, and the risk profile differs for individual ICS. Formulation particle size has been identified as a potential effect modifier. The present study compared the risk of pneumonia among new COPD users of fixed-dose combination inhalers containing fine-particle fluticasone (fp-FDC-F) versus extrafine particle beclometasone (ef-FDC-BDP). Methods: A propensity matched historical cohort study was conducted using data from the Optimum Patient Care Research Database. COPD patients aged >40 years with >1 year of continuous medical data who initiated fp-FDC-F or ef-FDC-BDP were compared. The 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. Results: A total of 13,316 patients were matched. Initiation of fp-FDC-F (mean dosage furoate 99 mu g; propionate 710 mu g) was associated with an increased risk of pneumonia versus ef-FDC-BDP (mean beclometasone dose 395 mu g), irrespective of definition (sensitive HR 1.38 95% CI 1.14-1.68; specific HR 1.31 95% CI 1.05-1.62). Conclusion: In the current investigation, we found that in comparison to extrafine beclomethasone, commencing a formulation containing fluticasone is associated with an increased risk of developing pneumonia. These observations support the idea that not all ICS are equal in their adverse effects and subclass variations exist and should be carefully considered in the treatment choice.