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Kholis FN, Pratama KG, Hadiyanto JN. Association between inhaled corticosteroid use and risk of hyperglycemia in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Tzu Chi Med J 2023; 35:355-361. [PMID: 38035057 PMCID: PMC10683519 DOI: 10.4103/tcmj.tcmj_131_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/13/2023] [Accepted: 08/04/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Chronic obstructive pulmonary disease (COPD) patients have a higher risk of developing diabetes, and studies suggest that inhaled corticosteroids (ICSs) use may be associated with a higher risk of diabetes, particularly at higher doses. This study aims to investigate the effects of ICS use on the risk of diabetes and blood glucose levels in COPD patients. Materials and Methods A systematic search was carried out on the PubMed, EBSCOhost, and ProQuest databases using the terms "Inhaled Corticosteroids," "Diabetes," and "Chronic Obstructive Pulmonary Disease" for the period between 2013 and 2023. The systematic review adhered to the PRISMA 2020 guideline. A meta-analysis was conducted using a random-effects model using the RevMan 5 software. Results A total of 14 studies were included in the final analysis, with 10 randomized controlled trials (RCTs) and 4 observational studies. Two observational studies investigated the relationship between ICS dose and diabetes risk. A meta-analysis of the RCTs studies showed a nonstatistically significant tendency toward increased blood glucose (odds ratio [OR] 1.07 and 95% confidence interval [CI] 0.88-1.30) after a 52-week follow-up. Whereas the observational studies showed a tendency toward an increased risk of diabetes (OR 1.40 and 95% CI 0.96-2.03). Furthermore, a subgroup meta-analysis of high-dose ICS (>900 μg/day) showed a significant increase in the risk of diabetes (OR 1.20 and 95% CI 1.09-1.32). Conclusion Short-term use of ICS does not have a significant effect on blood glucose. However, long-term use, especially at higher doses, can increase the risk of developing diabetes.
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Affiliation(s)
- Fathur Nur Kholis
- Divison of Pulmonology, Department of Internal Medicine, Faculty of Medicine, Dr. Kariadi General Hospital, Diponegoro University, Semarang, Central Java, Indonesia
| | | | - Jessica Novia Hadiyanto
- Department of Internal Medicine, Faculty of Medicine, Dr. Kariadi General Hospital, Diponegoro University, Semarang, Central Java, Indonesia
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2
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Donohue JF, Kerwin E, Barnes CN, Moran EJ, Haumann B, Crater GD. Efficacy of revefenacin, a long-acting muscarinic antagonist for nebulized therapy, in patients with markers of more severe COPD: a post hoc subgroup analysis. BMC Pulm Med 2020; 20:134. [PMID: 32393215 PMCID: PMC7216337 DOI: 10.1186/s12890-020-1156-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/20/2020] [Indexed: 12/24/2022] Open
Abstract
Background Revefenacin, a once-daily, long-acting muscarinic antagonist delivered via standard jet nebulizer, increased trough forced expiratory volume in 1 s (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. Trial registration Clinical trials registered with www.clinicaltrials.gov (Studies 0126 [NCT02459080; prospectively registered 22 May 2015] and 0127 [NCT02512510; prospectively registered 28 July 2015]).
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Affiliation(s)
- James F Donohue
- Pulmonary Medicine, UNC School of Medicine, 321 S Columbia St, Chapel Hill, NC, 27516, USA
| | - Edward Kerwin
- Clinical Research Institute of Southern Oregon, LLC, 3860 Crater Lake Ave, Medford, OR, 97504, USA
| | - Chris N Barnes
- Theravance Biopharma US, Inc., 901 Gateway Blvd, South San Francisco, CA, 94080, USA
| | - Edmund J Moran
- Theravance Biopharma US, Inc., 901 Gateway Blvd, South San Francisco, CA, 94080, USA
| | - Brett Haumann
- Theravance Biopharma US, Inc., 901 Gateway Blvd, South San Francisco, CA, 94080, USA
| | - Glenn D Crater
- Theravance Biopharma US, Inc., 901 Gateway Blvd, South San Francisco, CA, 94080, USA.
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3
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López-López N, Euba B, Hill J, Dhouib R, Caballero L, Leiva J, Hosmer J, Cuesta S, Ramos-Vivas J, Díez-Martínez R, Schirra HJ, Blank LM, Kappler U, Garmendia J. Haemophilus influenzae Glucose Catabolism Leading to Production of the Immunometabolite Acetate Has a Key Contribution to the Host Airway-Pathogen Interplay. ACS Infect Dis 2020; 6:406-421. [PMID: 31933358 DOI: 10.1021/acsinfecdis.9b00359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by abnormal inflammatory responses and impaired airway immunity, which provides an opportunistic platform for nontypeable Haemophilus influenzae (NTHi) infection. Clinical evidence supports that the COPD airways present increased concentrations of glucose, which may facilitate proliferation of pathogenic bacteria able to use glucose as a carbon source. NTHi metabolizes glucose through respiration-assisted fermentation, leading to the excretion of acetate, formate, and succinate. We hypothesized that such specialized glucose catabolism may be a pathoadaptive trait playing a pivotal role in the NTHi airway infection. To find out whether this is true, we engineered and characterized bacterial mutant strains impaired to produce acetate, formate, or succinate by inactivating the ackA, pflA, and frdA genes, respectively. While the inactivation of the pflA and frdA genes only had minimal physiological effects, the inactivation of the ackA gene affected acetate production and led to reduced bacterial growth, production of lactate under low oxygen tension, and bacterial attenuation in vivo. Moreover, bacterially produced acetate was able to stimulate the expression of inflammatory genes by cultured airway epithelial cells. These results back the notion that the COPD lung supports NTHi growth on glucose, enabling production of fermentative end products acting as immunometabolites at the site of infection. Thus, glucose catabolism may contribute not only to NTHi growth but also to bacterially driven airway inflammation. This information has important implications for developing nonantibiotic antimicrobials, given that airway glucose homeostasis modifying drugs could help prevent microbial infections associated with chronic lung disease.
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Affiliation(s)
| | - Begoña Euba
- Instituto de Agrobiotecnologı́a, CSIC-Gobierno Navarra, 31192 Mutilva, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
| | - Julian Hill
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Rabeb Dhouib
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Lucı́a Caballero
- Instituto de Agrobiotecnologı́a, CSIC-Gobierno Navarra, 31192 Mutilva, Spain
| | - José Leiva
- Servicio de Microbiologı́a, Clı́nica Universidad de Navarra, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Jennifer Hosmer
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Sergio Cuesta
- Instituto de Agrobiotecnologı́a, CSIC-Gobierno Navarra, 31192 Mutilva, Spain
| | - José Ramos-Vivas
- Servicio Microbiologı́a, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL), 39011 Santander, Spain
- Red Española de Investigación en Patologı́a Infecciosa (REIPI), ISCIII, Madrid, Spain
| | - Roberto Díez-Martínez
- Telum Therapeutics, Centro Europeo de Empresas e Innovación de Navarra (CEIN), 31110 Noáin, Spain
| | - Horst Joachim Schirra
- Centre for Advanced Imaging, The University of Queensland, 4072 St Lucia, Queensland, Australia
| | - Lars M. Blank
- Institute of Applied Biotechnology, RWTH Aachen University, 52074 Aachen, Germany
| | - Ulrike Kappler
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Queensland 4072, Australia
| | - Junkal Garmendia
- Instituto de Agrobiotecnologı́a, CSIC-Gobierno Navarra, 31192 Mutilva, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
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4
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Wong L, Tadrous M. Topical corticosteroids and type 2 diabetes mellitus: a critical appraisal. Br J Dermatol 2019; 183:37-38. [PMID: 31883374 DOI: 10.1111/bjd.18853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- L Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - M Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada
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5
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Katsiki N, Steiropoulos P, Papanas N, Mikhailidis DP. Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: An Overview. Exp Clin Endocrinol Diabetes 2019; 129:699-704. [PMID: 31739346 DOI: 10.1055/a-1038-3883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common disease with an increasing prevalence, characterised by persistent respiratory symptoms and airflow limitation. Apart from cigarette smoking, certain occupational and environmental exposures, low socioeconomic status and genetic factors may contribute to the pathogenesis of COPD. Comorbidities, e. g. diabetes mellitus (DM), can negatively affect quality of life, COPD outcomes and cardiovascular risk. The present narrative review considers the potential links between COPD and DM, such as systemic inflammation, oxidative stress, hypoxaemia and hyperglycaemia. The effects of antidiabetic drugs on lung function and COPD outcomes, as well as the possibility of common therapeutic modalities are also briefly considered. Further research is needed in this field to elucidate these relationships as well as their potential clinical implications in daily practice.
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Affiliation(s)
- Niki Katsiki
- First Department of Internal Medicine, Diabetes Centre, Division of Endocrinology and Metabolism, AHEPA University Hospital, Thessaloniki, Greece
| | - Paschalis Steiropoulos
- Department of Pneumonology, Democritus University of Thrace School of Health Sciences, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, University College London, Royal Free Hospital Campus, London, United Kingdom of Great Britain and Northern Ireland
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6
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Malte Rasmussen S, Brok J, Backer V, Francis Thomsen S, Meteran H. Association Between Chronic Obstructive Pulmonary Disease and Type 2 Diabetes: A Systematic Review and Meta-Analysis. COPD 2019; 15:526-535. [DOI: 10.1080/15412555.2018.1532495] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
| | - Jesper Brok
- Department of Paediatric and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Howraman Meteran
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
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7
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Agusti A, Fabbri LM, Singh D, Vestbo J, Celli B, Franssen FME, Rabe KF, Papi A. Inhaled corticosteroids in COPD: friend or foe? Eur Respir J 2018; 52:13993003.01219-2018. [PMID: 30190269 DOI: 10.1183/13993003.01219-2018] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 08/23/2018] [Indexed: 12/28/2022]
Abstract
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, e.g. 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-1, 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 (BMI), greater overall fragility, receiving higher ICS doses and those with blood eosinophils <100 cells·µL-1 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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Affiliation(s)
- Alvar Agusti
- Respiratory Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBER Enfermedades Respiratorias, Spain
| | - Leonardo M Fabbri
- Dept of Medicine, University of Ferrara, Ferrara, Italy.,COPD Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dave Singh
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK.,Medicines Evaluation Unit, Manchester, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Bartolome Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frits M E Franssen
- Dept of Research and Education, CIRO, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Hospital, Maastricht, The Netherlands
| | - Klaus F Rabe
- LungenClinic Großhansdorf, member of the German Center for Lung Research (DZL), Großhansdorf, Germany.,Christian Albrechts Universität Kiel, member of the German Center for Lung Research (DZL), Kiel, Germany
| | - Alberto Papi
- Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy
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8
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Zhong N, Wang C, Zhou X, Zhang N, Humphries M, Wang L, Patalano F, Banerji D. Efficacy and Safety of Indacaterol/Glycopyrronium (IND/GLY) Versus Salmeterol/Fluticasone in Chinese Patients with Moderate-to-Severe Chronic Obstructive Pulmonary Disease: The Chinese Cohort from the LANTERN Study. COPD 2016; 13:686-692. [PMID: 27715335 DOI: 10.1080/15412555.2016.1182970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Inhaled indacaterol/glycopyrronium fixed-dose combination (IND/GLY) is approved in over 80 countries, including the EU, Japan, Australia and Switzerland and the US. The LANTERN study evaluated the efficacy of IND/GLY compared with inhaled long-acting β2-agonist (LABA)/inhaled corticosteroid (ICS) or salmeterol/fluticasone (SFC) in patients with moderate-to-severe COPD with a history of ≤1 exacerbation in the previous year. Here we present the efficacy and safety of IND/GLY versus SFC in the Chinese cohort from the LANTERN study. LANTERN was a 26-week, multicenter, randomized, double-blind, double-dummy, parallel-group study conducted in patients with moderate-to-severe COPD with a history of ≤1 exacerbation in the previous year. The patients were randomized (1:1) to once-daily IND/GLY (110/50 μg) or twice-daily SFC (50/500 μg). The primary endpoint was non-inferiority of IND/GLY versus SFC in terms of trough FEV1. Of the total 744 patients randomized in the LANTERN study, 598 (80.4%) were from Mainland China and randomized to IND/GLY (n = 298) or SFC (n = 300), and 553 (92.5%) completed the study. IND/GLY showed superiority over SFC with a statistically significant and clinically meaningful improvement in trough FEV1, FEV1 AUC0-4h, peak FEV1 and trough forced vital capacity (FVC) change from the baseline. Annualized rate of moderate or severe COPD exacerbations was significantly lower (43%) with IND/GLY compared with SFC (rate ratio: 0.57, p = 0.015). Overall, adverse events were lower for IND/GLY (34.6%) versus SFC (43.1%). IND/GLY was superior in achieving bronchodilation versus SFC in a Chinese subgroup of patients from this study. Clinicaltrials.gov identifier: NCT01709903.
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Affiliation(s)
- Nanshan Zhong
- a State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China
| | - Changzheng Wang
- b Institute of Respiratory Disease, Xin Qiao Hospital, Third Military Medical University , Chongqing City , Chongqing , China
| | - Xiangdong Zhou
- c Department of Respiratory Medicine , Southwest Hospital, Third Military Medical University , Chongqing City , Chongqing , China
| | - Nuofu Zhang
- a State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong , China
| | | | - Linda Wang
- d Beijing Novartis Pharma Co. Ltd. , Shanghai , China
| | | | - Donald Banerji
- f Novartis Pharmaceuticals Corporation , East Hanover , New Jersey , USA
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