Risk of active tuberculosis among COPD patients treated with fixed combinations of long-acting beta2 agonists and inhale
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RESEARCH ARTICLE
Open Access
Risk of active tuberculosis among COPD patients treated with fixed combinations of long-acting beta2 agonists and inhaled corticosteroids Tsan-Ming Huang1†, Kuan-Chih Kuo2†, Ya-Hui Wang3, Cheng-Yi Wang1, Chih-Cheng Lai4* , Hao-Chien Wang5*, Likwang Chen6, Chong-Jen Yu5 and On the behalf of Taiwan Clinical Trial Consortium for Respiratory Diseases (TCORE)
Abstract Objectives: To investigate the incidence of active tuberculosis (TB) among COPD patients using fluticasone/ salmeterol or budesonide/formoterol, and to identify any differences between these two groups of patients. Methods: The study enrolled COPD patients from Taiwan NHIRD who received treatment with fluticasone/ salmeterol or budesonide/formoterol for > 90 days between 2004 and 2011. The incidence of active TB was the primary outcome. Results: Among the intention-to-treat population prior to matching, the incidence rates of active TB were 0.94 and 0.61% in the fluticasone/salmeterol and budesonide/formoterol groups, respectively. After matching, the fluticasone/salmeterol group had significantly higher rates of active TB (adjusted HR, 1.41, 95% CI, 1.17–1.70) compared with the budesonide/formoterol group. The significant difference between these two groups remained after a competing risk analysis (HR, 1.45, 95% CI, 1.21–1.74). Following propensity score matching, the fluticasone/ salmeterol group had significantly higher rates of active TB compared with the budesonide/formoterol group (adjusted HR, 1.45, 95% CI, 1.14–1.85). A similar trend was observed after a competing risk analysis (HR, 1.44, 95% CI, 1.19–1.75). A higher risk of active TB was observed in the fluticasone/salmeterol group compared with the budesonide/formoterol group across all subgroups, but some differences did not reach statistical significance. Conclusion: Fluticasone/salmeterol carried a higher risk of active TB compared with budesonide/formoterol among COPD patients. Keywords: Fluticasone/salmeterol, Budesonide/formoterol, COPD, Tuberculosis
* Correspondence: [email protected]; [email protected] † Tsan-Ming Huang and Kuan-Chih Kuo contributed equally to this work. 4 Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan 5 Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included
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