COPD: high-dose inhaled corticosteroids tied to diabetes, osteoporosis

Takeaway

• A large matched cohort study finds that patients with COPD who are initiated on inhaled corticosteroids (ICS) at mean daily doses of ≥500 μg (vs lower daily doses) are at risk for onset of type 2 diabetes mellitus (T2DM), progression of T2DM, and onset of osteoporosis.

Why this matters

• Patients with COPD initiated on ICS should be monitored for T2DM and osteoporosis.

Study design

• Matched cohort study using 2 large UK primary care databases: the Clinical Practice Research Datalink and the Optimum Patient Care Research Database (1983-2016).
• Patients were divided into 3 cohorts:
  • T2DM cohort (n=17,970).
  • T2DM progression cohort (n=804).
  • Osteoporosis cohort (n=19,898).
• Funding: None disclosed.

Key results

• Initiation of ICS therapy (vs long-acting bronchodilator [LABD]) was associated with a 27% increase in risk for T2DM (adjusted HR [aHR], 1.27; 95% CI, 1.07-1.50), but no increase in T2DM progression risk (aHR, 1.04; 95% CI, 0.87-1.25) or osteoporosis risk (aHR, 1.13; 95% CI, 0.93-1.39).
• ICS at mean daily doses ≥500 μg (vs <250 μg/day fluticasone propionate-equivalent) were associated with up to 50% increase in risk for T2DM onset, up to 2.4 times the risk of T2DM progression, and up to 97% increased risk for osteoporosis (all confidence intervals do not include 1).

Limitations

• Retrospective, observational design.