1 School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
2 Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
Chron Respir Dis. 2019 Jan-Dec;16:1479973118815694. doi: 10.1177/1479973118815694.
To examine clinical outcomes of theophylline use in patients with chronic obstructive pulmonary disease (COPD) receiving inhaled corticosteroids (ICS) and long-acting beta-2 agonists (LABA). Electronic data from five hospitals located in Northern Thailand between January 2011 and December 2015 were retrospectively collected. Propensity score (PS) matching (2:1 ratio) technique was used to minimize confounding factors. The primary outcome was overall exacerbations. Secondary outcomes were exacerbation not leading to hospital admission, hospitalization for exacerbation, hospitalization for pneumonia, and all-cause hospitalizations. Cox's proportional hazards models were used to estimate adjusted hazard ratio (aHR) and 95% confidence interval (CI). After PS matching, of 711 patients with COPD (mean age: 70.1 years; 74.4% male; 60.8% severe airflow obstruction), 474 theophylline users and 237 non-theophylline users were included. Mean follow-up time was 2.26 years. Theophylline significantly increased the risk of overall exacerbation (aHR: 1.48, 95% CI: 1.11-1.96; p = 0.008) and exacerbation not leading to hospital admission (aHR: 1.47, 95% CI: 1.06-2.03; p = 0.020). Theophylline use did not significantly increase the risk of hospitalization for exacerbation (aHR: 1.11, 95% CI: 0.79-1.58; p = 0.548), hospitalization for pneumonia (aHR: 1.28, 95% CI: 0.89-1.84; p = 0.185), and all-cause hospitalizations (aHR: 1.03, 95% CI: 0.80-1.33; p = 0.795). Theophylline use as add-on therapy to ICS and LABA might be associated with an increased risk for overall exacerbation in patients with COPD. A large-scale prospective study of theophylline use investigating both safety and efficacy is warranted.
观察在接受吸入性皮质类固醇（ICS）和长效β2 激动剂（LABA）治疗的慢性阻塞性肺疾病（COPD）患者中茶碱的临床疗效。
回顾性收集 2011 年 1 月至 2015 年 12 月期间位于泰国北部的五家医院的电子数据。采用倾向评分（PS）匹配（2:1 比例）技术来最小化混杂因素。主要结局为总体恶化。次要结局为无住院治疗的恶化、因恶化而住院、因肺炎而住院和全因住院。采用 Cox 比例风险模型来估计调整后的危险比（aHR）和 95%置信区间（CI）。
在经过 PS 匹配后，纳入了 711 例 COPD 患者（平均年龄：70.1 岁；74.4%为男性；60.8%为严重气流阻塞），其中 474 例茶碱使用者和 237 例非茶碱使用者。平均随访时间为 2.26 年。茶碱显著增加了总体恶化的风险（aHR：1.48，95%CI：1.11-1.96；p=0.008）和无住院治疗的恶化风险（aHR：1.47，95%CI：1.06-2.03；p=0.020）。茶碱的使用并未显著增加恶化而住院的风险（aHR：1.11，95%CI：0.79-1.58；p=0.548）、因肺炎而住院的风险（aHR：1.28，95%CI：0.89-1.84；p=0.185）和全因住院的风险（aHR：1.03，95%CI：0.80-1.33；p=0.795）。
在 COPD 患者中，ICS 和 LABA 联合茶碱治疗可能与总体恶化风险增加相关。需要进行一项大规模的前瞻性研究，以评估茶碱的安全性和疗效。
