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Comparative safety of inhaled corticosteroids and macrolides in Medicare enrolees with bronchiectasis
INTRODUCTION: Bronchiectasis is an increasingly common chronic inflammatory airway disease. We evaluated secondary safety outcomes in a comparative effectiveness study of chronic inhaled corticosteroids (ICS) and macrolide monotherapy in bronchiectasis patients. METHODS: We conducted a retrospective...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Respiratory Society
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8899493/ https://www.ncbi.nlm.nih.gov/pubmed/35265701 http://dx.doi.org/10.1183/23120541.00786-2020 |
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author | Henkle, Emily Daley, Charles L. Curtis, Jeffrey R. Chan, Benjamin Aksamit, Timothy R. Winthrop, Kevin L. |
author_facet | Henkle, Emily Daley, Charles L. Curtis, Jeffrey R. Chan, Benjamin Aksamit, Timothy R. Winthrop, Kevin L. |
author_sort | Henkle, Emily |
collection | PubMed |
description | INTRODUCTION: Bronchiectasis is an increasingly common chronic inflammatory airway disease. We evaluated secondary safety outcomes in a comparative effectiveness study of chronic inhaled corticosteroids (ICS) and macrolide monotherapy in bronchiectasis patients. METHODS: We conducted a retrospective study using US Medicare Parts A, B and D (but not C) 2006–2014 datasets. Among those with a pulmonologist-associated bronchiectasis claim (ICD-9-CM 494.0 or 494.1), without cystic fibrosis, we identified the first new use of either chronic (>28 days) ICS or macrolide monotherapy. For each drug exposure, we calculated crude incidence rates of the secondary safety outcomes: arrhythmia, myocardial infarction, sensorineural hearing loss, hip fracture and opportunistic infections. We calculated a propensity score (PS) for ICS use using demographic, clinical and utilisation characteristics and compared risks of macrolides versus ICS for each outcome using PS decile-adjusted Cox regression models. RESULTS: Of 285 043 Medicare patients with bronchiectasis, we identified 6500 (2%) macrolide and 83 589 (29%) ICS new users. Key covariates were balanced across exposure groups within decile. Myocardial infarction, hip fracture and opportunistic infection were not significantly associated with treatment. Macrolides were associated with a decreased risk of arrhythmia (adjusted hazard ratio (aHR) 0.87, 95% CI 0.80–0.94) and an increased risk of sensorineural hearing loss (aHR 1.38, 95% CI 1.56–1.22) compared to ICS. CONCLUSIONS: Macrolides were not associated with an elevated risk of acute cardiac events compared to ICS. The increased risk of hearing loss in macrolide users compared to ICS users in older bronchiectasis patients should be balanced against known benefits of macrolides. |
format | Online Article Text |
id | pubmed-8899493 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-88994932022-03-08 Comparative safety of inhaled corticosteroids and macrolides in Medicare enrolees with bronchiectasis Henkle, Emily Daley, Charles L. Curtis, Jeffrey R. Chan, Benjamin Aksamit, Timothy R. Winthrop, Kevin L. ERJ Open Res Original Research Articles INTRODUCTION: Bronchiectasis is an increasingly common chronic inflammatory airway disease. We evaluated secondary safety outcomes in a comparative effectiveness study of chronic inhaled corticosteroids (ICS) and macrolide monotherapy in bronchiectasis patients. METHODS: We conducted a retrospective study using US Medicare Parts A, B and D (but not C) 2006–2014 datasets. Among those with a pulmonologist-associated bronchiectasis claim (ICD-9-CM 494.0 or 494.1), without cystic fibrosis, we identified the first new use of either chronic (>28 days) ICS or macrolide monotherapy. For each drug exposure, we calculated crude incidence rates of the secondary safety outcomes: arrhythmia, myocardial infarction, sensorineural hearing loss, hip fracture and opportunistic infections. We calculated a propensity score (PS) for ICS use using demographic, clinical and utilisation characteristics and compared risks of macrolides versus ICS for each outcome using PS decile-adjusted Cox regression models. RESULTS: Of 285 043 Medicare patients with bronchiectasis, we identified 6500 (2%) macrolide and 83 589 (29%) ICS new users. Key covariates were balanced across exposure groups within decile. Myocardial infarction, hip fracture and opportunistic infection were not significantly associated with treatment. Macrolides were associated with a decreased risk of arrhythmia (adjusted hazard ratio (aHR) 0.87, 95% CI 0.80–0.94) and an increased risk of sensorineural hearing loss (aHR 1.38, 95% CI 1.56–1.22) compared to ICS. CONCLUSIONS: Macrolides were not associated with an elevated risk of acute cardiac events compared to ICS. The increased risk of hearing loss in macrolide users compared to ICS users in older bronchiectasis patients should be balanced against known benefits of macrolides. European Respiratory Society 2022-03-07 /pmc/articles/PMC8899493/ /pubmed/35265701 http://dx.doi.org/10.1183/23120541.00786-2020 Text en Copyright ©The authors 2022 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org) |
spellingShingle | Original Research Articles Henkle, Emily Daley, Charles L. Curtis, Jeffrey R. Chan, Benjamin Aksamit, Timothy R. Winthrop, Kevin L. Comparative safety of inhaled corticosteroids and macrolides in Medicare enrolees with bronchiectasis |
title | Comparative safety of inhaled corticosteroids and macrolides in Medicare enrolees with bronchiectasis |
title_full | Comparative safety of inhaled corticosteroids and macrolides in Medicare enrolees with bronchiectasis |
title_fullStr | Comparative safety of inhaled corticosteroids and macrolides in Medicare enrolees with bronchiectasis |
title_full_unstemmed | Comparative safety of inhaled corticosteroids and macrolides in Medicare enrolees with bronchiectasis |
title_short | Comparative safety of inhaled corticosteroids and macrolides in Medicare enrolees with bronchiectasis |
title_sort | comparative safety of inhaled corticosteroids and macrolides in medicare enrolees with bronchiectasis |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8899493/ https://www.ncbi.nlm.nih.gov/pubmed/35265701 http://dx.doi.org/10.1183/23120541.00786-2020 |
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