Emily Henkle, Jeffrey R. Curtis, Lang Chen, Benjamin Chan, Timothy R. Aksamit, Charles L. Daley, David E. Griffith, Kevin L. Winthrop
European Respiratory Journal 2019; DOI: 10.1183/13993003.01896-2018
Introduction Non-cystic fibrosis bronchiectasis (“bronchiectasis”) is a chronic airway disease for which little data exist to inform treatment decisions. We sought to compare the risks of respiratory infections in chronic users of inhaled corticosteroids (ICS) versus macrolide monotherapy.
Methods We identified a cohort of U.S. Medicare enrollees with a bronchiectasis diagnosis (494.0/494.1) between 2006 and 2014, excluding cystic fibrosis. We defined chronic new use as the first 28+ day prescription of ICS or macrolide monotherapy. We compared characteristics of the exposure cohorts using standardised mean differences (SMD) and computed a propensity score (PS) to account for treatment differences. The risks of acute exacerbation, hospitalised respiratory infection, all-cause hospitalisation, and mortality were compared using PS decile-adjusted Cox regression models.
Results We identified 83 589 new users of ICS and 6500 of macrolides from 285 043 included Medicare enrollees with bronchiectasis. The crude incidence of hospitalised respiratory infection was 12.6 (ICS) and 10.3 (macrolide) per 100 patient-years. The PS-adjusted hazard comparing ICS to macrolide new-users was 1.39 (95% CI 1.23–1.57) for hospitalised respiratory infection, 1.56 (1.49–1.64) for acute exacerbation, and 1.09 (0.95–1.25) for mortality.
Interpretation Among patients with bronchiectasis, the use of ICS was associated with an increased risk of hospitalised respiratory infections compared to macrolide monotherapy.
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Conflict of interest: Dr. Winthrop reports personal fees from Bayer, outside the submitted work.
Conflict of interest: Dr. Chan has nothing to disclose.
Conflict of interest: Dr. Daley reports grants from Insmed, outside the submitted work.
Conflict of interest: Dr. Aksamit has nothing to disclose.
Conflict of interest: Dr. Chen has nothing to disclose.
Conflict of interest: Dr. Curtis has nothing to disclose.
Conflict of interest: Dr. Griffith has nothing to disclose.
Conflict of interest: Dr. Henkle has nothing to disclose.