Current Perspectives on the Contribution of Inhaled Corticosteroids to an Increased Risk for Diabetes Onset and Progression in Patients with Chronic Obstructive Pulmonary Disease

Herth, Felix; Bramlage, Peter; Müller‐Wieland, Dirk

doi:10.1159/000368371

Cited by 11 publications

(9 citation statements)

References 67 publications

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“…Thus, in clinical practice, it seems advisable to discontinue ICS if repeated episodes of pneumonia are documented (albeit there is no proof of increased risk of death from these pneumonias [79,119]). Analyses of large databases also suggest that ICS use in COPD is associated with increased risk of diabetes (RR 1.34 (95% CI 1.29-1.39)) [120,121], particularly with the highest ICS doses (⩾1000 µg per day fluticasone equivalent; RR 1.64 (1.52-1.76)) [120,121], cataract (current ICS users had twice the risk of incident posterior subcapsular cataract; OR 2.5 (1.3-4.7)) or incident nuclear cataract (OR 2.0 (1.2-3.4)) [122] and osteoporosis/fractures (OR 1.21 (1.12-1.32) ICS current or ever users versus non-users) [123,124], so these potential undesired side effects need to be monitored in clinical practice. Finally, it is important to consider that the dose or specific type of ICS molecule used may also influence the risk for undesired outcomes [119,125].…”

Section: Clinical Markers Of Potential Ics Riskmentioning

confidence: 99%

Inhaled corticosteroids in COPD: friend or foe?

et al. 2018

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The efficacy, safety and positioning of inhaled corticosteroids (ICS) in the treatment of patients with chronic obstructive pulmonary disease (COPD) is much debated, since it can result in clear clinical benefits in some patients ("friend") but can be ineffective or even associated with undesired side effects, pneumonia, in others ("foe"). After critically reviewing the evidence for and against ICS treatment in patients with COPD, we propose that: 1) ICS should not be used as a single, stand-alone therapy in COPD; 2) patients most likely to benefit from the addition of ICS to long-acting bronchodilators include those with history of multiple or severe exacerbations despite appropriate maintenance bronchodilator use, particularly if blood eosinophils are>300 cells·µL, and those with a history of and/or concomitant asthma; and 3) the risk of pneumonia in COPD patients using ICS is higher in those with older age, lower body mass index, greater overall fragility, receiving higher ICS doses and those with blood eosinophils <100 cells·µL All these factors must be carefully considered and balanced in any individual COPD patient before adding ICS to her/his maintenance bronchodilator treatment. Further research is needed to clarify some of these issues and firmly establish these recommendations.

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Section: Clinical Markers Of Potential Ics Riskmentioning

confidence: 99%

Inhaled corticosteroids in COPD: friend or foe?

et al. 2018

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“…Similarly, nebulized glycopyrrolate improved FEV 1 , and patient-reported outcomes in patients with COPD, irrespective of cardiovascular risk status [24]. In previous studies of patients with COPD and comorbid type 2 diabetes, ICS therapy may have a negative impact on diabetes control, and patients prescribed higher doses may be at greater risk of diabetes progression [25,26]. In the GOLD report, combination ICS/ LABA or LAMA/LABA or LAMA monotherapy are recommended for GOLD D patients [1].…”

Section: Discussionmentioning

confidence: 86%

Efficacy of revefenacin, a long-acting muscarinic antagonist for nebulized therapy, in patients with markers of more severe COPD: a post hoc subgroup analysis

et al. 2020

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Background: Revefenacin, a once-daily, long-acting muscarinic antagonist delivered via standard jet nebulizer, increased trough forced expiratory volume in 1 s (FEV 1) in patients with moderate to very severe chronic obstructive pulmonary disease (COPD) in prior phase 3 trials. We evaluated the efficacy of revefenacin in patients with markers of more severe COPD. Methods: A post hoc subgroup analysis of two replicate, randomized, phase 3 trials was conducted over 12 weeks. Endpoints included least squares change from baseline in trough FEV 1 , St. George's Respiratory Questionnaire (SGRQ) responders, and transition dyspnea index (TDI) responders at Day 85. This analysis included patient subgroups at high risk for COPD exacerbations and compared patients who received revefenacin 175 μg and placebo: severe and very severe airflow limitation (percent predicted FEV 1 30%-< 50% and < 30%), 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) D, reversibility (≥ 12% and ≥ 200 mL increase in FEV 1) to short-acting bronchodilators, concurrent use of long-acting β agonists and/or inhaled corticosteroids, older age (> 65 and > 75 years), and comorbidity risk factors. Results: Revefenacin demonstrated significant improvements in FEV 1 versus placebo at Day 85 among the intention-to-treat (ITT) population and all subgroups. Additionally, there was a greater number of SGRQ and TDI responders in the ITT population and the majority of subgroups analyzed among patients who received revefenacin versus placebo. For the SGRQ responders, the odds of response (odds ratio > 2.0) were significantly greater in the revefenacin arm versus the placebo arm among the severe airflow obstruction, very severe airflow obstruction and 2011 GOLD D subgroups. For the TDI responders, the odds of response (odds ratio > 2.0) were significantly greater among the severe airflow obstruction subgroup and patients aged > 75 years.

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“…Similarly, nebulized glycopyrrolate improved FEV 1 , and patient-reported outcomes in patients with COPD, irrespective of cardiovascular risk status [24]. In previous studies of patients with COPD and comorbid type 2 diabetes, ICS therapy may have a negative impact on diabetes control, and patients prescribed higher doses may be at greater risk of diabetes progression [25,26]. In the GOLD report, combination ICS/LABA or LAMA/LABA or LAMA monotherapy are recommended for GOLD D patients [1].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of revefenacin, a long-acting muscarinic antagonist for nebulized therapy, in patients with markers of more severe COPD: a post hoc subgroup analysis

Donohue¹,

Kerwin

Barnes

et al. 2020

Preprint

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Background: Revefenacin, a once-daily, long-acting muscarinic antagonist delivered via standard jet nebulizer, increased trough forced expiratory volume in 1 second (FEV1) in patients with moderate to very severe chronic obstructive pulmonary disease (COPD) in prior phase 3 trials. We evaluated the efficacy of revefenacin in patients with markers of more severe COPD. Methods: A post hoc subgroup analysis of two replicate, randomized, phase 3 trials was conducted over 12 weeks. Endpoints included least squares change from baseline in trough FEV1, St. George’s Respiratory Questionnaire (SGRQ) responders, and transition dyspnea index (TDI) responders at Day 85. This analysis included patient subgroups at high risk for COPD exacerbations and compared patients who received revefenacin 175 μg and placebo: severe and very severe airflow limitation (percent predicted FEV1 30%–<50% and <30%), 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) D, reversibility (≥12% and ≥200 mL increase in FEV1) to short-acting bronchodilators, concurrent use of long-acting β agonists and/or inhaled corticosteroids, older age (>65 and >75 years), and comorbidity risk factors. Results: Revefenacin demonstrated significant improvements in FEV1 versus placebo at Day 85 among the intention-to-treat (ITT) population and all subgroups. Additionally, there was a greater number of SGRQ and TDI responders in the ITT population and the majority of subgroups analyzed among patients who received revefenacin versus placebo. For the SGRQ responders, the odds of response (odds ratio >2.0) were significantly greater in the revefenacin arm versus the placebo arm among the severe airflow obstruction, very severe airflow obstruction and 2011 GOLD D subgroups. For the TDI responders, the odds of response (odds ratio >2.0) were significantly greater among the severe airflow obstruction subgroup and patients aged >75 years. Conclusions: Revefenacin showed significantly greater improvements in FEV1 versus placebo in the ITT population and all subgroups. Furthermore, there were a greater number of SGRQ and TDI responders in the ITT population, and in the majority of patient subgroups among patients who received revefenacin versus placebo. Based on the data presented, revefenacin could be a therapeutic option among patients with markers of more severe COPD.

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Current Perspectives on the Contribution of Inhaled Corticosteroids to an Increased Risk for Diabetes Onset and Progression in Patients with Chronic Obstructive Pulmonary Disease

Cited by 11 publications

References 67 publications

Inhaled corticosteroids in COPD: friend or foe?

Inhaled corticosteroids in COPD: friend or foe?

Efficacy of revefenacin, a long-acting muscarinic antagonist for nebulized therapy, in patients with markers of more severe COPD: a post hoc subgroup analysis

Efficacy of revefenacin, a long-acting muscarinic antagonist for nebulized therapy, in patients with markers of more severe COPD: a post hoc subgroup analysis

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