| アブストラクト | AIMS: C-reactive protein (CRP) is an important biomarker in systemic inflammation in COPD; reports have suggested inhaled corticosteroids (ICS) attenuate CRP levels. We evaluated the risk of moderate-to-severe exacerbations, severe exacerbations and all-cause mortality among patients with COPD currently exposed to Inhaled corticosteroids (ICS) stratified by CRP levels compared to never ICS users with low CRP levels. METHODS: We included subjects age 40 or more who had a diagnosis of COPD from January 1, 2005 to January 31, 2014 from the UK Clinical Practice Research Datalink (CPRD). ICS exposure was determined time-dependently, as current, recent, past or never users. We evaluated the risk of moderate-to-severe exacerbations, severe exacerbations and all-cause mortality among ICS users stratified by CRP levels. RESULTS: 17,722 subjects diagnosed with COPD met the inclusion criteria. Among current or never ICS with elevated CRP levels we found, no significantly reduced risk of moderate-to-severe or severe exacerbations. For patients currently exposed ICS with CRP levels >/=8 mg/L there was no reduced risk of moderate-to-severe exacerbations (adjusted hazard ratio [adj. HR] 0.99; 95% confidence interval [CI] 0.76-1.31) or severe exacerbations (adj.HR 1.52; 95% CI 0.71-3.27). However, we found an increased risk of all-cause mortality among COPD patients with CRP levels >/=8 mg/L irrespective of ICS exposure. CONCLUSION: We did not find a reduced risk of moderate and/or severe COPD exacerbations among COPD patients with varying CRP levels currently exposed to ICS. However, low-grade systemic inflammation was associated with all-cause mortality among COPD patients. |
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| 投稿者 | Oshagbemi, Olorunfemi A; Franssen, Frits M E; Wouters, Emiel F M; Maitland-van der Zee, Anke H; Driessen, Johanna H M; de Boer, Anthonius; de Vries, Frank |
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| 組織名 | Department of Clinical Pharmacy and Toxicology, Maastricht University Medical;Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht;(CARIM), Maastricht University, the Netherlands; Division of Pharmacoepidemiology;and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht,;the Netherlands; CIRO, Horn, the Netherlands; Department of Respiratory Medicine,;Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands;;Department of Epidemiology, Care and Public Health Research Institute (CAPHRI),;Maastricht University, the Netherlands.;CIRO, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht;University Medical Centre (MUMC+), Maastricht, the Netherlands.;University Medical Centre (MUMC+), Maastricht, the Netherlands; Department of;Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht;University, the Netherlands.;Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of;Pharmaceutical Sciences, Utrecht, the Netherlands; Department of Respiratory;Medicine, Academic University Medical Centre, University of Amsterdam (UvA);Amsterdam, the Netherlands.;the Netherlands.;Pharmaceutical Sciences, Utrecht, the Netherlands.;the Netherlands. Electronic address: f.devries@uu.nl. |
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