Inhaled Corticosteroids And Risk Of Tuberculosis In Patients With Obstructive Lung Diseases: A Systematic Review And Meta-Analysis Of Non-randomized Studies.
infection control
inhaled corticosteroids
meta-analysis
obstructive lung disease
tuberculosis
Journal
International journal of chronic obstructive pulmonary disease
ISSN: 1178-2005
Titre abrégé: Int J Chron Obstruct Pulmon Dis
Pays: New Zealand
ID NLM: 101273481
Informations de publication
Date de publication:
2019
2019
Historique:
received:
19
03
2019
accepted:
10
07
2019
entrez:
3
10
2019
pubmed:
3
10
2019
medline:
17
4
2020
Statut:
epublish
Résumé
An association between systemic corticosteroids and tuberculosis (TB) is reported in the literature. Here within, we conducted a systematic review and meta-analysis to evaluate the effects of inhaled corticosteroids (ICS) on the risk of TB in patients with obstructive lung diseases. The review was registered on PROSPERO (CRD42018095874). PubMed, CENTRAL, Scopus and Web of Science were searched from inception to September 2018. Papers reporting cases of incident TB in patients with obstructive lung diseases were included; studies without data on ICS use were excluded. Simultaneous use of oral corticosteroids (OCS) and population attributable fraction (PAF) for TB from ICS exposure were also assessed. Data were analyzed using a generic inverse variance method with a random-effects model. ORs with 95% CI were estimated. Out of 4044 retrieved papers, 9 articles evaluating adult patients only were included in the review. 36,351 patients were prescribed ICS, while 147,171 were not. Any ICS use was associated with an increased risk of TB versus no ICS use (OR=1.46; 95% CI 1.06 to 2.01; p=0.02; I Despite the association between ICS and TB, the contribution of this risk factor to the epidemiology of TB seems to be limited. As a consequence, no population-based interventions are warranted. Rather, this risk should be taken into account on an individual basis, particularly in those patients with a high risk of progression from LTBI to TB.
Sections du résumé
Background
An association between systemic corticosteroids and tuberculosis (TB) is reported in the literature. Here within, we conducted a systematic review and meta-analysis to evaluate the effects of inhaled corticosteroids (ICS) on the risk of TB in patients with obstructive lung diseases.
Methods
The review was registered on PROSPERO (CRD42018095874). PubMed, CENTRAL, Scopus and Web of Science were searched from inception to September 2018. Papers reporting cases of incident TB in patients with obstructive lung diseases were included; studies without data on ICS use were excluded. Simultaneous use of oral corticosteroids (OCS) and population attributable fraction (PAF) for TB from ICS exposure were also assessed. Data were analyzed using a generic inverse variance method with a random-effects model. ORs with 95% CI were estimated.
Results
Out of 4044 retrieved papers, 9 articles evaluating adult patients only were included in the review. 36,351 patients were prescribed ICS, while 147,171 were not. Any ICS use was associated with an increased risk of TB versus no ICS use (OR=1.46; 95% CI 1.06 to 2.01; p=0.02; I
Conclusions
Despite the association between ICS and TB, the contribution of this risk factor to the epidemiology of TB seems to be limited. As a consequence, no population-based interventions are warranted. Rather, this risk should be taken into account on an individual basis, particularly in those patients with a high risk of progression from LTBI to TB.
Identifiants
pubmed: 31576118
doi: 10.2147/COPD.S209273
pii: 209273
pmc: PMC6769028
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2219-2227Informations de copyright
© 2019 Castellana et al.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
Références
PLoS One. 2016 Jul 22;11(7):e0159683
pubmed: 27448321
Thorax. 2013 Mar;68(3):256-62
pubmed: 22781123
Eur Respir J. 1991 Nov;4(10):1288-95
pubmed: 1804678
Arch Intern Med. 1999 May 10;159(9):941-55
pubmed: 10326936
Arthritis Care Res (Hoboken). 2013 Aug;65(8):1343-57
pubmed: 23335588
Eur Respir J. 2014 Apr;43(4):1201-3
pubmed: 24176996
Emerg Microbes Infect. 2016 Feb 03;5:e10
pubmed: 26839146
Rheum Dis Clin North Am. 2016 Feb;42(1):157-76, ix-x
pubmed: 26611557
Lancet. 2009 May 30;373(9678):1905-17
pubmed: 19482216
J Allergy Clin Immunol Pract. 2019 Feb;7(2):641-648.e1
pubmed: 30130591
Int J Clin Pract. 2014 Oct;68(10):1193-9
pubmed: 24838040
Ann Intern Med. 2009 Aug 18;151(4):W65-94
pubmed: 19622512
Eur Respir J. 2017 Sep 20;50(3):
pubmed: 28931659
Ther Adv Respir Dis. 2016 Jun;10(3):235-55
pubmed: 26893311
J Thorac Dis. 2014 Jul;6(7):971-8
pubmed: 25093095
Thorax. 2013 Nov;68(11):1029-36
pubmed: 24130228
Chest. 2014 Jun;145(6):1286-1297
pubmed: 24504044
Lancet. 2018 Nov 10;392(10159):1789-1858
pubmed: 30496104
Arthritis Rheum. 2006 Feb 15;55(1):19-26
pubmed: 16463407
Am J Respir Crit Care Med. 2000 Apr;161(4 Pt 2):S221-47
pubmed: 10764341
Thorax. 2013 Dec;68(12):1105-13
pubmed: 23749841
Inhal Toxicol. 2017 Apr;29(5):219-226
pubmed: 28714745
PLoS One. 2016 Jul 22;11(7):e0159012
pubmed: 27448309
Lancet. 2010 May 22;375(9728):1814-29
pubmed: 20488524
Respirology. 2010 May;15(4):603-22
pubmed: 20409026
Pharmaceuticals (Basel). 2010 Mar 08;3(3):514-540
pubmed: 27713266
Chest. 2013 Apr;143(4):1018-1024
pubmed: 23079688
Am J Respir Crit Care Med. 2011 Mar 1;183(5):675-8
pubmed: 20889902
Eur Respir J. 2019 May 18;53(5):null
pubmed: 30846476
Medicine (Baltimore). 2010 Jan;89(1):53-61
pubmed: 20075705
Eur Respir J. 2002 Apr;19(4):765-75
pubmed: 11999007
J Allergy Clin Immunol. 2013 Mar;131(3):636-45
pubmed: 23360759
Qual Assur Util Rev. 1990 Aug;5(3):86-9
pubmed: 2136670
BMC Cancer. 2016 Oct 10;16(1):778
pubmed: 27724847