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Inhaled corticosteroids and the risk of lung cancer in chronic obstructive pulmonary disease (COPD):
Jumat, 03 Mei 2019 17:47:39

A.J.N. RaymakersM. SadatsafaviD.D. SinJ.M. FitzGeraldC.A. MarraL.D. Lynd

European Respiratory Journal 2019; DOI: 10.1183/13993003.01257-2018

Abstract

Inhaled corticosteroids are often prescribed in patients with chronic obstructive pulmonary disease (COPD). Their impact on the risk of lung cancer, a leading cause of mortality in COPD patients, is unknown.

Population-based linked administrative data between the years 1997–2007 from the province of British Columbia, Canada were used to evaluate the association between lung cancer risk and ICS use in COPD patients. COPD was defined on the basis of receipt of three COPD-related prescriptions in subjects 50 years of age or greater. Exposure to ICS was incorporated into multivariable Cox regression models using several time-dependent methods (“ever” exposure, cumulative duration of use, cumulative dose, weighted cumulative duration of use, and weighted cumulative dose).

There were 39,676 patients who met the inclusion criteria. The mean age of the cohort was 70.7 (sd: 11.1) years and 53% were female. There were 994 (2.5%) cases of lung cancer during follow-up. In the reference-case analysis (time-dependent “ever” exposure), ICS exposure was associated with a 30% reduced risk of lung cancer (HR: 0.70 (95% CI: 0.61–0.80)). ICS exposure was associated with a decrease in the risk of lung cancer diagnosis over all five methods of quantifying exposure.

This population-based study suggests that ICS use reduces the risk of lung cancer in COPD patients.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Raymakers has nothing to disclose.

Conflict of interest: Dr. FitzGerald has nothing to disclose.

Conflict of interest: Dr. Lynd reports grants from Canadian Institute for Health Research, during the conduct of the study; grants from Astra Zeneca, outside the submitted work.

Conflict of interest: Dr. Marra has nothing to disclose.

Conflict of interest: Dr. Sin reports grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, grants from Merck Frosst, personal fees from Novartis, outside the submitted work.

Conflict of interest: Dr. Sadatsafavi has nothing to disclose.