Comparative risks of chronic inhaled corticosteroids and macrolides for bronchiectasis

Area of Science:

• Pulmonology
• Pharmacology
• Epidemiology

Background:

• Non-cystic fibrosis bronchiectasis is a chronic airway disease with limited treatment guidelines.
• Existing data are insufficient to guide therapeutic decisions, particularly regarding inhaled corticosteroids (ICSs) versus macrolide monotherapy.

Purpose of the Study:

• To compare the risks of respiratory infections in patients with bronchiectasis using inhaled corticosteroids (ICSs) versus macrolide monotherapy.
• To evaluate the association between ICS use and adverse respiratory events in this patient population.

Main Methods:

• A cohort study of US Medicare enrollees diagnosed with bronchiectasis between 2006 and 2014 was conducted.
• New users of ICSs or macrolide monotherapy were identified, and propensity score adjustment was used to control for confounding factors.
• Cox regression models compared risks of acute exacerbation, hospitalised respiratory infection, hospitalisation, and mortality between the two groups.

Main Results:

• The study identified 83,589 new ICS users and 6,500 new macrolide users among 285,043 eligible patients.
• The incidence of hospitalised respiratory infection was 12.6 per 100 patient-years for ICS users and 10.3 for macrolide users.
• Propensity score-adjusted analyses showed a 39% increased risk of hospitalised respiratory infection (HR 1.39) for ICS users compared to macrolide users.

Conclusions:

• Inhaled corticosteroid (ICS) use in patients with bronchiectasis is associated with an elevated risk of hospitalised respiratory infections when compared to macrolide monotherapy.
• These findings suggest that macrolide monotherapy may be a preferred treatment option for reducing infection risk in this patient group.