Department of Pharmacy Practice, Albany College Pharmacy and Health Sciences, Albany, NY, USA.
Global Medical Affairs, AstraZeneca, Gaithersburg, MD, USA.
Int J Chron Obstruct Pulmon Dis. 2020 Nov 11;15:2889-2900. doi: 10.2147/COPD.S269637. eCollection 2020.
Inhaled corticosteroids (ICS) are widely used and recommended to treat chronic obstructive pulmonary disease (COPD). While generally considered safe, several studies demonstrated an increased risk of pneumonia with the use of ICS in COPD patients. Although all ICS indicated for COPD carry the class labeling warning of increased pneumonia risk, evidence suggests an intraclass difference in the risk of pneumonia between inhaled budesonide and fluticasone. To date, systematic reviews of direct-comparison studies have not been performed to assess if an intraclass difference exists.
This review investigated whether there is an intraclass difference in risk of pneumonia between inhaled fluticasone and budesonide, the 2 most commonly used ICS in COPD.
A search of the medical literature was conducted in PubMed and Embase for the time period of 01/01/69-05/31/19. The search strategy combined terms that defined the patient/disease type, exposures, outcome, and the study/publication type. Descriptive and comparative statistics reported for fluticasone- and budesonide-containing products in each study, including data for pneumonia event subgroups, were extracted and reported by dose, seriousness, or practice setting. Controlled clinical trials and observational studies meeting the inclusion criteria were assessed for methodologic quality by using the appropriate tool from the list of study quality assessment tools developed by the National Institutes of Health.
The summary relative risk (RR) ratio across 5 included studies (57,199 patients) was 1.13 (95% CI: 1.09-1.19), representing a 13.5% increased risk of pneumonia among fluticasone users compared to budesonide users. Similarly, summary RR ratio for serious pneumonia implied a 14.4% increased risk of serious pneumonia among fluticasone users compared to budesonide users (pooled RR: 1.14; 95% CI: 1.09-1.20).
There is likely a clinically important intraclass difference in the risk of pneumonia between fluticasone- and budesonide-containing inhaled medications in COPD.
吸入性皮质类固醇（ICS）被广泛应用并推荐用于治疗慢性阻塞性肺疾病（COPD）。虽然一般认为是安全的，但有几项研究表明，ICS 在 COPD 患者中的使用会增加肺炎的风险。尽管所有用于 COPD 的 ICS 都带有增加肺炎风险的类别标签警告，但有证据表明吸入布地奈德和氟替卡松之间存在肺炎风险的类内差异。迄今为止，尚未进行直接比较研究的系统评价来评估是否存在类内差异。
本综述调查了 COPD 中最常用的两种 ICS，即吸入氟替卡松和布地奈德之间，肺炎风险是否存在类内差异。
在 PubMed 和 Embase 中进行了医学文献检索，检索时间为 01/01/69-05/31/19。搜索策略结合了定义患者/疾病类型、暴露、结局以及研究/出版物类型的术语。从每个研究中提取并报告了含有氟替卡松和布地奈德产品的描述性和比较性统计数据，包括肺炎事件亚组的数据，按剂量、严重程度或实践环境报告。使用国家卫生研究院开发的研究质量评估工具清单中的适当工具评估符合纳入标准的对照临床试验和观察性研究的方法学质量。
5 项纳入研究（57199 名患者）的汇总相对风险（RR）比为 1.13（95%CI：1.09-1.19），这意味着与布地奈德使用者相比，氟替卡松使用者患肺炎的风险增加了 13.5%。同样，严重肺炎的汇总 RR 比表明，与布地奈德使用者相比，氟替卡松使用者患严重肺炎的风险增加了 14.4%（汇总 RR：1.14；95%CI：1.09-1.20）。
在 COPD 中，氟替卡松和布地奈德吸入药物之间的肺炎风险可能存在临床重要的类内差异。
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