安定した慢性閉塞性肺疾患の患者における吸入用コルチコステロイド:体系的なレビューとメタ解析
M Bradley Drummond1, Elliott C Dasenbrook, Marshall W Pitz
1Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
JAMA
|November 27, 2008
まとめ
COPDに対する吸入用コルチコステロイド (ICS) 治療は死亡率に影響を与えませんが,肺炎のリスクを高めます. ICS治療から恩恵を受ける可能性のある患者のサブセットを特定するために,さらなる研究が必要です.
科学分野:
- 肺内医学 肺内医学 肺内医学
- クリニック・トライアル 臨床試験
- 薬理学 薬理学とは
背景:
- 安定した慢性阻害性肺疾患 (COPD) に対して,吸入性コルチコステロイド (ICS) 治療の有効性と安全性に関する矛盾する証拠が存在します.
- 懸念事項には,生存に対する潜在的な影響と有害事象のリスクが含まれています.
研究 の 目的:
- 安定したCOPD患者の死亡率と有害事象に対するICS療法の影響を体系的にレビューし,定量的に合成する.
- 既存のランダム化対照試験の包括的なメタ分析を提供する.
主な方法:
- 複数のデータベース (MEDLINE,CENTRAL,EMBASEなど) での包括的な文献検索 2008年2月まででした.
- COPD患者におけるICS療法 (≥6ヶ月) と非ステロイド療法の双重ブラインド,ランダム化対照試験 (RCT) を含む.
- データ抽象は,研究の特徴,あらゆる原因による死亡率,肺炎,骨折に焦点を当て,メタアナリシスは,異質性に基づくランダムまたは固定効果モデルを使用して行われました.
主要な成果:
- 14,426人の参加者を含む11件のRCTを分析した.
- ICSと対照群の1年間の全原因死亡率において有意な差は認められなかった (RR,0.86;95%CI,0.68-1.09).
- ICS治療は,肺炎の有意に高い発生率 (RR, 1.34; 95% CI, 1.03-1.75) と関連しており,特に高用量,より短い持続時間,基礎肺機能の低下,および併用療法と関連していました.
結論:
- 吸入用コルチコステロイド療法は,COPD患者における1年間の全原因死亡率に影響を与えない.
- 肺炎のリスクの顕著な増加は,COPD管理におけるICSの使用と関連しています.
- ICS療法から利益を得ることができる特定のCOPD患者のサブグループを特定するためにさらなる研究が必要である.
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