Dong Yaa-Hui, Chang Chia-Hsuin, Wu Fe-Lin Lin, Shen Li-Jiuan, Calverley Peter M A, Löfdahl Claes-Göran, Lai Mei-Shu, Mahler Donald A
National Taiwan University Health Data Research Center, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, and Department of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Center of Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Department of Internal Medicine, Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
Graduate Institute of Clinical Pharmacy, and Department of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Center of Comparative Effectiveness Research, National Center of Excellence for Clinical Trial and Research, Department of Internal Medicine, Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
Chest. 2014 Jun;145(6):1286-1297. doi: 10.1378/chest.13-2137.
Background: The use of inhaled corticosteroids (ICSs) is associated with an increased risk of pneumonia in patients with COPD. However, the risks of other respiratory infections, such as TB and influenza, remain unclear.Methods: Through a comprehensive literature search of MEDLINE, EMBASE, CINAHL, Cochrane Library, and ClinicalTrials.gov from inception to July 2013, we identified randomized controlled trials of ICS therapy lasting at least 6 months. We conducted meta-analyses by the Peto, Mantel-Haenszel, and Bayesian approaches to generate summary estimates comparing ICS with non-ICS treatment on the risk of TB and influenza.Results: Twenty-fi ve trials (22,898 subjects) for TB and 26 trials (23,616 subjects) for influenza were included. Compared with non-ICS treatment, ICS treatment was associated with a significantly higher risk of TB (Peto OR, 2.29; 95% CI, 1.04-5.03) but not influenza (Peto OR, 1.24;95% CI, 0.94-1.63). Results were similar with each meta-analytic approach. Furthermore, the number needed to harm to cause one additional TB event was lower for patients with COPD treated with ICSs in endemic areas than for those in nonendemic areas (909 vs 1,667, respectively).Conclusions: This study raises safety concerns about the risk of TB and influenza associated with ICS use in patients with COPD, which deserve further investigation.
慢性阻塞性肺疾病（COPD）患者使用吸入性糖皮质激素（ICSs）与肺炎风险增加相关。然而，其他呼吸道感染（如结核病和流感）的风险仍不明确。
通过全面检索MEDLINE、EMBASE、CINAHL、Cochrane图书馆和ClinicalTrials.gov，从建库至2013年7月，我们确定了持续至少6个月的ICS治疗随机对照试验。我们采用Peto法、Mantel-Haenszel法和贝叶斯法进行荟萃分析，以得出ICS与非ICS治疗在结核病和流感风险方面的汇总估计值。
纳入了25项结核病试验（22898名受试者）和26项流感试验（23616名受试者）。与非ICS治疗相比，ICS治疗与结核病风险显著升高相关（Peto比值比，2.29；95%可信区间，1.04 - 5.03），但与流感无关（Peto比值比，1.24；95%可信区间，0.94 - 1.63）。每种荟萃分析方法的结果相似。此外，在流行地区接受ICS治疗的COPD患者发生一例额外结核病事件的伤害所需人数低于非流行地区患者（分别为909和1667）。
本研究引发了对COPD患者使用ICS与结核病和流感风险相关的安全担忧，值得进一步研究。
