Risk of pneumonia with inhaled corticosteroid/long-acting β2 agonist therapy in chronic obstructive pulmonary disease: a cluster analysis
Rachael L DiSantostefano,1 Hao Li,1 David Hinds,1 Dmitry V Galkin,2 David B Rubin21Worldwide Epidemiology, 2Respiratory Clinical Development, GlaxoSmithKline, Research Triangle Park, Durham, NC, USABackground: Pneumonia poses a significant risk in patients with moderate to severe chronic obstructive...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2014-05-01
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| Series: | International Journal of COPD |
| Online Access: | http://www.dovepress.com/risk-of-pneumonia-with-inhaled-corticosteroidlong-acting-beta2-agonist-a16714 |
| _version_ | 1811263786215014400 |
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| author | DiSantostefano RL Li H Hinds D Galkin DV Rubin DB |
| author_facet | DiSantostefano RL Li H Hinds D Galkin DV Rubin DB |
| author_sort | DiSantostefano RL |
| collection | DOAJ |
| description | Rachael L DiSantostefano,1 Hao Li,1 David Hinds,1 Dmitry V Galkin,2 David B Rubin21Worldwide Epidemiology, 2Respiratory Clinical Development, GlaxoSmithKline, Research Triangle Park, Durham, NC, USABackground: Pneumonia poses a significant risk in patients with moderate to severe chronic obstructive pulmonary disease but data are limited on the disease phenotypes most susceptible to pneumonia.Methods: Cluster analysis using a data-driven recursive partitioning algorithm was employed using baseline data from two pooled one-year randomized exacerbation trials (n=3,255) of fluticasone furoate/vilanterol or vilanterol alone to identify distinct patient groups at greatest risk of pneumonia or serious (hospitalization or death) pneumonia.Results: Five clusters were identified. Patients at greater risk of first pneumonia had more severe obstruction (forced expiratory volume in one second/forced vital capacity <46%) and either a body mass index <19 kg/m2 (hazard ratio 7.8, 95% confidence interval 4.7–13.0; n=144) or a pneumonia history and greater comorbidities (hazard ratio 4.8, 95% confidence interval 3.0–7.7; n=374) relative to the cluster with the lowest pneumonia risk (reference; n=1310). Multiple comorbidities and use of psychoanaleptics also contributed to an increased risk of pneumonia in more obstructed patients. Independent of cluster, use of inhaled corticosteroids was associated with pneumonia (hazard ratio 1.89, 95% confidence interval 1.25–2.84) and serious pneumonia (hazard ratio 2.92, 95% confidence interval 1.40–6.01).Conclusion: Cluster analysis can identify patient populations at risk for serious safety outcomes and inform risk management strategies to optimize patient management. The greatest risk for pneumonia was in subjects with multiple pneumonia risk factors.Keywords: chronic obstructive pulmonary disease, inhaled corticosteroids, long-acting β2-agonists, pneumonia, cluster analysis |
| first_indexed | 2024-04-12T19:51:30Z |
| format | Article |
| id | doaj.art-e72188e9c2494c9d915524d4c0c6ba79 |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-04-12T19:51:30Z |
| publishDate | 2014-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-e72188e9c2494c9d915524d4c0c6ba792022-12-22T03:18:50ZengDove Medical PressInternational Journal of COPD1178-20052014-05-012014default45746816714Risk of pneumonia with inhaled corticosteroid/long-acting β2 agonist therapy in chronic obstructive pulmonary disease: a cluster analysisDiSantostefano RLLi HHinds DGalkin DVRubin DBRachael L DiSantostefano,1 Hao Li,1 David Hinds,1 Dmitry V Galkin,2 David B Rubin21Worldwide Epidemiology, 2Respiratory Clinical Development, GlaxoSmithKline, Research Triangle Park, Durham, NC, USABackground: Pneumonia poses a significant risk in patients with moderate to severe chronic obstructive pulmonary disease but data are limited on the disease phenotypes most susceptible to pneumonia.Methods: Cluster analysis using a data-driven recursive partitioning algorithm was employed using baseline data from two pooled one-year randomized exacerbation trials (n=3,255) of fluticasone furoate/vilanterol or vilanterol alone to identify distinct patient groups at greatest risk of pneumonia or serious (hospitalization or death) pneumonia.Results: Five clusters were identified. Patients at greater risk of first pneumonia had more severe obstruction (forced expiratory volume in one second/forced vital capacity <46%) and either a body mass index <19 kg/m2 (hazard ratio 7.8, 95% confidence interval 4.7–13.0; n=144) or a pneumonia history and greater comorbidities (hazard ratio 4.8, 95% confidence interval 3.0–7.7; n=374) relative to the cluster with the lowest pneumonia risk (reference; n=1310). Multiple comorbidities and use of psychoanaleptics also contributed to an increased risk of pneumonia in more obstructed patients. Independent of cluster, use of inhaled corticosteroids was associated with pneumonia (hazard ratio 1.89, 95% confidence interval 1.25–2.84) and serious pneumonia (hazard ratio 2.92, 95% confidence interval 1.40–6.01).Conclusion: Cluster analysis can identify patient populations at risk for serious safety outcomes and inform risk management strategies to optimize patient management. The greatest risk for pneumonia was in subjects with multiple pneumonia risk factors.Keywords: chronic obstructive pulmonary disease, inhaled corticosteroids, long-acting β2-agonists, pneumonia, cluster analysishttp://www.dovepress.com/risk-of-pneumonia-with-inhaled-corticosteroidlong-acting-beta2-agonist-a16714 |
| spellingShingle | DiSantostefano RL Li H Hinds D Galkin DV Rubin DB Risk of pneumonia with inhaled corticosteroid/long-acting β2 agonist therapy in chronic obstructive pulmonary disease: a cluster analysis International Journal of COPD |
| title | Risk of pneumonia with inhaled corticosteroid/long-acting β2 agonist therapy in chronic obstructive pulmonary disease: a cluster analysis |
| title_full | Risk of pneumonia with inhaled corticosteroid/long-acting β2 agonist therapy in chronic obstructive pulmonary disease: a cluster analysis |
| title_fullStr | Risk of pneumonia with inhaled corticosteroid/long-acting β2 agonist therapy in chronic obstructive pulmonary disease: a cluster analysis |
| title_full_unstemmed | Risk of pneumonia with inhaled corticosteroid/long-acting β2 agonist therapy in chronic obstructive pulmonary disease: a cluster analysis |
| title_short | Risk of pneumonia with inhaled corticosteroid/long-acting β2 agonist therapy in chronic obstructive pulmonary disease: a cluster analysis |
| title_sort | risk of pneumonia with inhaled corticosteroid long acting beta 2 agonist therapy in chronic obstructive pulmonary disease a cluster analysis |
| url | http://www.dovepress.com/risk-of-pneumonia-with-inhaled-corticosteroidlong-acting-beta2-agonist-a16714 |
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