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Comparative risks of chronic inhaled corticosteroids and macrolides for bronchiectasis
Selasa, 21 Mei 2019 10:32:24

Emily HenkleJeffrey R. CurtisLang ChenBenjamin ChanTimothy R. AksamitCharles L. DaleyDavid E. GriffithKevin L. Winthrop

European Respiratory Journal 2019; DOI: 10.1183/13993003.01896-2018

Abstract

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.

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. 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.