Association between Increased Risk of Pneumonia with ICS in COPD: A Continuous Variable Analysis of Patient Factors from the IMPACT Study.
COPD
ICS
IMPACT
Pneumonia risk
Post hoc analysis
Journal
Pulmonary therapy
ISSN: 2364-1746
Titre abrégé: Pulm Ther
Pays: United States
ID NLM: 101687144
Informations de publication
Date de publication:
06 Mar 2024
06 Mar 2024
Historique:
received:
11
01
2024
accepted:
08
02
2024
medline:
6
3
2024
pubmed:
6
3
2024
entrez:
6
3
2024
Statut:
aheadofprint
Résumé
Despite the proven benefits of inhaled corticosteroid (ICS)-containing triple therapy for chronic obstructive pulmonary disease (COPD), clinicians limit patient exposure to ICS due to the risk of pneumonia. However, there are multiple factors associated with the risk of pneumonia in patients with COPD. This post hoc analysis of IMPACT trial data aims to set the risks associated with ICS into a context of specific patient-related factors that contribute to the risk of pneumonia. The 52-week, double-blind IMPACT trial randomized patients with symptomatic COPD and ≥1 exacerbation in the prior year 2:2:1 to once-daily fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI), FF/VI or UMEC/VI. Annual rate of on-treatment pneumonias in the intent-to-treat population associated with age, body mass index (BMI), percent predicted forced expiratory volume in 1 s (FEV This analysis revealed that the annual rate of pneumonia showed the lowest risk at the age of 50 years. The 95% confidence intervals (CI) between ICS-containing and non-ICS containing treatments diverged in ages > 63 years, suggesting a significantly increased ICS-related risk in older patients. In contrast, the annual rate of pneumonia rose in both groups below BMI of 22.5 kg/m There was little evidence of a differential effect of older age, lower BMI, lower FEV IMPACT ClinicalTrials.gov number, NCT02164513.
Identifiants
pubmed: 38446336
doi: 10.1007/s41030-024-00255-1
pii: 10.1007/s41030-024-00255-1
doi:
Banques de données
ClinicalTrials.gov
['NCT02164513']
Types de publication
Journal Article
Langues
eng
Informations de copyright
© 2024. The Author(s).
Références
Lipson DA, Barnacle H, Birk R, et al. FULFIL trial: once-daily triple therapy for patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;196(4):438–46. https://doi.org/10.1164/rccm.201703-0449OC .
doi: 10.1164/rccm.201703-0449OC
pubmed: 28375647
Halpin DMG, Worsley S, Ismaila AS, et al. INTREPID: single- versus multiple-inhaler triple therapy for COPD in usual clinical practice. ERJ Open Res. 2021;7(2):00950–2020. https://doi.org/10.1183/23120541.00950-2020 .
doi: 10.1183/23120541.00950-2020
pubmed: 34109236
pmcid: 8181617
Lipson DA, Barnhart F, Brealey N, et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD. N Engl J Med. 2018;378(18):1671–80. https://doi.org/10.1056/NEJMoa1713901 .
doi: 10.1056/NEJMoa1713901
pubmed: 29668352
Williams NP, Coombs NA, Johnson MJ, et al. Seasonality, risk factors and burden of community-acquired pneumonia in COPD patients: a population database study using linked health care records. Int J Chronic Obstruct Pulmon Dis. 2017;12:313–22. https://doi.org/10.2147/COPD.S121389 .
doi: 10.2147/COPD.S121389
Crim C, Calverley PMA, Anderson JA, et al. Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results. Eur Respir J 34:641–647. https://doi.org/10.1183/09031936.00193908 .
doi: 10.1183/09031936.00193908
pubmed: 32162970
pmcid: 7301738
Hartley BF, Barnes NC, Lettis S, Compton CH, Papi A, Jones P. Risk factors for exacerbations and pneumonia in patients with chronic obstructive pulmonary disease: a pooled analysis. Respir Res. 2020;21(1):5. https://doi.org/10.1186/s12931-019-1262-0 .
doi: 10.1186/s12931-019-1262-0
pubmed: 31907054
pmcid: 6945447
Crim C, Dransfield MT, Bourbeau J, et al. Pneumonia risk with inhaled fluticasone furoate and vilanterol compared with vilanterol alone in patients with COPD. Ann Am Thorac Soc. 2015;12(1):27–34. https://doi.org/10.1513/AnnalsATS.201409-413OC .
doi: 10.1513/AnnalsATS.201409-413OC
pubmed: 25490706
Müllerova H, Chigbo C, Hagan GW, et al. The natural history of community-acquired pneumonia in COPD patients: a population database analysis. Respir Med. 2012;106(8):1124–33. https://doi.org/10.1016/j.rmed.2012.04.008 .
doi: 10.1016/j.rmed.2012.04.008
pubmed: 22621820
Restrepo MI, Mortensen EM, Pugh JA, Anzueto A. COPD is associated with increased mortality in patients with community-acquired pneumonia. Eur Respir J. 2006;28(2):346–51. https://doi.org/10.1183/09031936.06.00131905 .
doi: 10.1183/09031936.06.00131905
pubmed: 16611653
Lin SH, Ji BC, Shih YM, et al. Comorbid pulmonary disease and risk of community-acquired pneumonia in COPD patients. Int J Tuberc Lung Dis. 2013;17(12):1638–44. https://doi.org/10.5588/ijtld.13.0330 .
doi: 10.5588/ijtld.13.0330
pubmed: 24200282
Pavord ID, Lettis S, Anzueto A, Barnes N. Blood eosinophil count and pneumonia risk in patients with chronic obstructive pulmonary disease: a patient-level meta-analysis. Lancet Respir Med. 2016;4(9):731–41. https://doi.org/10.1016/S2213-2600(16)30148-5 .
doi: 10.1016/S2213-2600(16)30148-5
pubmed: 27460163
Martinez-Garcia MA, Faner R, Oscullo G, et al. Inhaled steroids, circulating eosinophils, chronic airway infection, and pneumonia risk in chronic obstructive pulmonary disease. A network analysis. Am J Respir Crit Care Med. 2020;201(9):1078–85. https://doi.org/10.1164/rccm.201908-1550OC .
doi: 10.1164/rccm.201908-1550OC
pubmed: 31922913
Singh R, Alape D, de Lima A, Ascanio J, Majid A, Gangadharan SP. Regulatory T cells in respiratory health and diseases. Pulm Med. 2019;20(2019):1907807. https://doi.org/10.1155/2019/1907807 .
doi: 10.1155/2019/1907807
Müllerova H, Maselli DJ, Locantore N, et al. Hospitalized exacerbations of COPD: risk factors and outcomes in the ECLIPSE cohort. Chest. 2015;147(4):999–1007. https://doi.org/10.1378/chest.14-0655 .
doi: 10.1378/chest.14-0655
pubmed: 25356881
Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010;363:1128–38. https://doi.org/10.1056/NEJMoa0909883 .
doi: 10.1056/NEJMoa0909883
pubmed: 20843247
Adibi A, Sin DD, Safari A, et al. The acute COPD exacerbation prediction tool (ACCEPT): a modelling study. Lancet Respir Med. 2020;8(10):1013–21. https://doi.org/10.1016/S2213-2600(19)30397-2 .
doi: 10.1016/S2213-2600(19)30397-2
pubmed: 32178776
Singh D, Litewka D, Páramo R, et al. DElaying disease progression in COPD with early initiation of dual bronchodilator or triple inhaled pharmacotherapy (DEPICT): a predictive modelling approach. Adv Ther. 2023;40(10):4282–97. https://doi.org/10.1007/s12325-023-02583-1 .
doi: 10.1007/s12325-023-02583-1
pubmed: 37382864
pmcid: 10499693
Bourbeau J, Bafadhel M, Barnes NC, et al. Benefit/risk profile of single-inhaler triple therapy in COPD. Int J Chronic Obstruct Pulmon Dis. 2021;1(16):499–517. https://doi.org/10.2147/COPD.S291967 .
doi: 10.2147/COPD.S291967
Miravitlles M, Acharya S, Aggarwal B, et al. Clinical concepts for triple therapy use in patients with COPD: a Delphi consensus. Int J Chronic Obstruct Pulmon Dis. 2023;28(18):1853–66. https://doi.org/10.2147/COPD.S424128 .
doi: 10.2147/COPD.S424128
Anzueto A, Cohen M, Echazarreta AL, et al. Delphi consensus on clinical applications of GOLD 2023 recommendations in COPD management: how aligned are recommendations with clinical practice? Pulm Ther. 2023. https://doi.org/10.1007/s41030-023-00248-6 .
doi: 10.1007/s41030-023-00248-6
pubmed: 38112909
pmcid: 10881920