| アブストラクト | BACKGROUND: Oral corticosteroids (OCS) are often prescribed for chronic obstructive pulmonary disease (COPD) exacerbations. METHODS: This observational, individually matched historical cohort study used electronic medical records (1987-2019) from the UK Clinical Practice Research Datalink linked to English Hospital Episode Statistics (HES) to evaluate adverse outcomes in patients with COPD who used OCS (OCS cohort) and those not exposed to OCS (non-OCS cohort). Risk of 17 adverse outcomes was estimated using proportional hazard regression. RESULTS: Of 323,722 patients, 106,775 (33.0%) had COPD-related OCS prescriptions. Of the 106,775 patients in the overall cohort, 58,955 had HES linkage and were eligible for inclusion in the OCS cohort. The individual matching process identified 53,299 pairs of patients to form the OCS and non-OCS cohorts. Median follow-up post-index was 6.9 years (OCS cohort) and 5.4 years (non-OCS cohort). Adjusted risk of multiple adverse outcomes was higher for the OCS cohort versus the non-OCS cohort, including osteoporosis with/without fractures (adjusted hazard ratio [aHR] 1.80; 95% confidence interval [CI] 1.70-1.92), type 2 diabetes mellitus (aHR 1.44; 95% CI 1.37-1.51), cardiovascular/cerebrovascular disease (aHR 1.26; 95% CI 1.21-1.30), and all-cause mortality (aHR 1.04; 95% CI 1.02-1.07). In the OCS cohort, risk of most adverse outcomes increased with increasing categorized cumulative OCS dose. For example, risk of cardiovascular/cerebrovascular disease was 34% higher in the 1.0-<2.5 g group versus the <0.5 g group (HR 1.34; 95% CI 1.26-1.42). CONCLUSION: Any OCS use was associated with higher risk of adverse outcomes in patients with COPD, with risk generally increasing with greater cumulative OCS dose. |
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| ジャーナル名 | International journal of chronic obstructive pulmonary disease |
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| 投稿日 | 2023/11/29 |
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| 投稿者 | Tse, Gary; Emmanuel, Benjamin; Ariti, Cono; Bafadhel, Mona; Papi, Alberto; Carter, Victoria; Zhou, Jiandong; Skinner, Derek; Xu, Xiao; Mullerova, Hana; Price, David |
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| 組織名 | Observational and Pragmatic Research Institute, Singapore, Singapore.;School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong;Kong, People's Republic of China.;AstraZeneca, Gaithersburg, MD, USA.;Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty;of Life Sciences and Medicine, King's College London, London, UK.;Respiratory Medicine, Department of Translational Medicine, University of;Ferrara, Ferrara, Italy.;AstraZeneca, Cambridge, UK.;Centre of Academic Primary Care, Division of Applied Health Sciences, University;of Aberdeen, Aberdeen, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/38022830/ |
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