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

  • Price DB & al.
  • NPJ Prim Care Respir Med
  • 28 Oct 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

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

Limitations

  • Retrospective, observational design.