Risk of active tuberculosis among COPD patients treated with fixed combinations of long-acting beta2 agonists and inhaled corticosteroids
Tsan-Ming Huang, Kuan-Chih Kuo, Ya‐Hui Wang, Cheng‐Yi Wang, Chih‐Cheng Lai, Hao‐Chien Wang, Likwang Chen, Chong‐Jen Yu, Chong‐Jen Yu, Hao‐Chien Wang, Diahn‐Warng Perng, Shih-Lung Cheng, Jeng-Yuan Hsu, Wu-Huei Hsu, Jeng-Yuan Hsu, Wu-Huei Hsu, Ying-Huang Tsai, Tzuen‐Ren Hsiue, Meng‐Chih Lin, Hen-I Lin, Cheng‐Yi Wang, Yeun‐Chung Chang, Ueng‐Cheng Yang, Cing-Syong Lin, Likwang Chen, Yu‐Feng Wei, Inn‐Wen Chong, Chung‐Yu Chen
Abstract
OBJECTIVES: To investigate the incidence of active tuberculosis (TB) among COPD patients using fluticasone/salmeterol or budesonide/formoterol, and to identify any differences between these two groups of patients. METHODS: The study enrolled COPD patients from Taiwan NHIRD who received treatment with fluticasone/salmeterol or budesonide/formoterol for > 90 days between 2004 and 2011. The incidence of active TB was the primary outcome. RESULTS: Among the intention-to-treat population prior to matching, the incidence rates of active TB were 0.94 and 0.61% in the fluticasone/salmeterol and budesonide/formoterol groups, respectively. After matching, the fluticasone/salmeterol group had significantly higher rates of active TB (adjusted HR, 1.41, 95% CI, 1.17-1.70) compared with the budesonide/formoterol group. The significant difference between these two groups remained after a competing risk analysis (HR, 1.45, 95% CI, 1.21-1.74). Following propensity score matching, the fluticasone/salmeterol group had significantly higher rates of active TB compared with the budesonide/formoterol group (adjusted HR, 1.45, 95% CI, 1.14-1.85). A similar trend was observed after a competing risk analysis (HR, 1.44, 95% CI, 1.19-1.75). A higher risk of active TB was observed in the fluticasone/salmeterol group compared with the budesonide/formoterol group across all subgroups, but some differences did not reach statistical significance. CONCLUSION: Fluticasone/salmeterol carried a higher risk of active TB compared with budesonide/formoterol among COPD patients.