Abstract
Introduction Non-cystic fibrosis (CF) bronchiectasis (“bronchiectasis”) is a chronic airway disease for which little data exist to inform treatment decisions. We sought to compare the risks of respiratory infections in chronic users of inhaled corticosteroids (ICSs) versus macrolide monotherapy.
Methods We identified a cohort of US Medicare enrollees with a bronchiectasis diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification code 494.0 or 494.1) between 2006 and 2014, excluding CF. We defined chronic new use as the first ≥28-day prescription of ICS therapy or macrolide monotherapy. We compared the characteristics of the exposure cohorts using standardised mean differences (SMDs) and computed a propensity score (PS) to account for treatment differences. The risks of acute exacerbation, hospitalised respiratory infection, all-cause hospitalisation and mortality were compared using PS decile-adjusted Cox regression models.
Results We identified 83 589 new users of ICSs and 6500 new users of macrolides from 285 043 included Medicare enrollees with bronchiectasis. The crude incidence of hospitalised respiratory infection was 12.6 (ICS therapy) and 10.3 (macrolide monotherapy) per 100 patient-years. The PS-adjusted HRs comparing ICS with macrolide new users were 1.39 (95% CI 1.23–1.57) for hospitalised respiratory infection, 1.56 (95% 1.49–1.64) for acute exacerbation and 1.09 (95% 0.95–1.25) for mortality.
Interpretation Among patients with bronchiectasis, the use of ICSs was associated with an increased risk of hospitalised respiratory infections compared with macrolide monotherapy.
Abstract
Macrolides are a better choice than ICSs to prevent hospitalised respiratory infections in older bronchiectasis patients, but the safety and long-term effects of chronic macrolide use need to be further evaluated http://ow.ly/1SOV30o8eLs
Footnotes
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Author contributions: E. Henkle had full access to all of the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. E. Henkle drafted the manuscript. All other co-authors contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.
Conflict of interest: E. Henkle has nothing to disclose.
Conflict of interest: J.R. Curtis has nothing to disclose.
Conflict of interest: L. Chen has nothing to disclose.
Conflict of interest: B. Chan has nothing to disclose.
Conflict of interest: T.R. Aksamit has nothing to disclose.
Conflict of interest: C.L. Daley reports grants from Insmed, outside the submitted work.
Conflict of interest: D.E. Griffith has nothing to disclose.
Conflict of interest: K.L. Winthrop reports personal fees for consultancy from Bayer, outside the submitted work.
Support statement: Research reported in this manuscript was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (CER-1503-29191). The statements and conclusions in this manuscript are solely the responsibility of the authors and do not necessarily represent the views of the PCORI, its Board of Governors or Methodology Committee. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received October 8, 2018.
- Accepted March 14, 2019.
- Copyright ©ERS 2019