Association between ICS use and risk of hyperglycemia in COPD patients: systematic review and meta-analysis

Pu, Xiaofeng; Liu, Liang; Feng, Bimin; Zhang, Zh.; Wang, Guojun

doi:10.1186/s12931-021-01789-7

Cited by 8 publications

(3 citation statements)

References 34 publications

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“…Blood tests Metabolic and endocrine panel: Oral corticosteroids are none for their dysregulating effects on glucose homeostasis [ 29 ]. This dysregulation was not seen in retrospective studies [ 30 ]. However, prospective studies comparing asthma patients with and without ICS have not been performed recently, as guidelines recommend ICS in all patients [ 31 – 33 ].…”

Section: Methodsmentioning

confidence: 85%

STOP: an open label crossover trial to study ICS withdrawal in patients with a combination of obesity and low-inflammatory asthma and evaluate its effect on asthma control and quality of life

et al. 2022

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Background Asthma patients with obesity often have a high disease burden, despite the use of high-dose inhaled corticosteroids (ICS). In contrast to asthmatics with normal weight, the efficacy of ICS in patients with obesity and asthma is often relatively low. Meanwhile, patients do suffer from side effects, such as weight gain, development of diabetes, cataract, or high blood pressure. The relatively poor response to ICS might be explained by the low prevalence of type 2 inflammatory patterns (T2-low) in patients with asthma and obesity. T2-low inflammation is characterized by low eosinophilic count, low Fractional exhaled NO (FeNO), no clinically allergy-driven asthma, and no need for maintenance oral corticosteroids (OCS). We aim to study whether ICS can be safely withdrawn in patients with T2-low asthma and obesity while maintaining an equal level of asthma control. Secondary outcomes focus on the prevalence of ‘false-negative’ T2-low phenotypes (i.e. T2-hidden) and the effect of ICS withdrawal on parameters of the metabolic syndrome. This study will lead to a better understanding of this poorly understood subgroup and might find new treatable traits. Methods The STOP trial is an investigator-initiated, multicenter, non-inferiority, open-label, crossover study aiming to assess whether ICS can be safely withdrawn in adults aged 17–75 years with T2-low asthma and obesity (body mass index (BMI) ≥ 30 kg/m2). Patients will be randomly divided into two arms (both n = 60). One arm will start with fixed-dose ICS (control group) and one arm will taper and subsequently stop ICS (intervention group). Patients in the intervention group will remain ICS naïve for ten weeks. After a washout of 4 weeks, patients will crossover to the other study arm. The crossover study takes 36 weeks to complete. Patients will be asked to participate in the extension study, to investigate the long-term metabolic benefits of ICS withdrawal. Discussion This study yields valuable data on ICS tapering in patients with T2-low asthma and obesity. It informs future guidelines and committees on corticosteroid-sparing algorithms in these patients. Trial registration Netherlands Trial Register, NL8759, registered 2020–07-06, https://www.trialregister.nl/trial/8759. Protocol version and date: version 2.1, 20 November 2020.

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Section: Methodsmentioning

confidence: 85%

STOP: an open label crossover trial to study ICS withdrawal in patients with a combination of obesity and low-inflammatory asthma and evaluate its effect on asthma control and quality of life

et al. 2022

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“… 140 However, a systematic review and meta-analysis has concluded that the use of ICS does not influence blood glucose and is not associated with the incidence of new-onset DM or the progression of diabetes in patients with COPD. 141 Furthermore, the influence of ICS on DM remains uncertain. 142 However, glycosylated hemoglobin levels increased considerably after 6 weeks of inhaled fluticasone therapy in a small prospective crossover study in individuals with established T2DM.…”

Section: Type 2 Diabetes Mellitusmentioning

confidence: 99%

Cardiovascular diseases or type 2 diabetes mellitus and chronic airway diseases: mutual pharmacological interferences

Cazzola

Rogliani

Ora

et al. 2023

Therapeutic Advances in Chronic Disease

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Chronic airway diseases (CAD), mainly asthma and chronic obstructive pulmonary disease (COPD), are frequently associated with different comorbidities. Among them, cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) pose problems for the simultaneous treatment of CAD and comorbidity. Indeed, there is evidence that some drugs used to treat CAD negatively affect comorbidity, and, conversely, some drugs used to treat comorbidity may aggravate CAD. However, there is also growing evidence of some beneficial effects of CAD drugs on comorbidities and, conversely, of the ability of some of those used to treat comorbidity to reduce the severity of lung disease. In this narrative review, we first describe the potential cardiovascular risks and benefits for patients using drugs to treat CAD and the potential lung risks and benefits for patients using drugs to treat CVD. Then, we illustrate the possible negative and positive effects on T2DM of drugs used to treat CAD and the potential negative and positive impact on CAD of drugs used to treat T2DM. The frequency with which CAD and CVD or T2DM are associated requires not only considering the effect that drugs used for one disease condition may have on the other but also providing an opportunity to develop therapies that simultaneously favorably impact both diseases.

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“…The use of COPD medications is generally safe in patients with T2DM, but the effect of ICS on DM remains uncertain [53]. A systematic review and meta-analysis of 17 RCTs involving 43,430 subjects concluded that in patients with COPD, the use of ICS does not affect blood glucose levels and is not associated with the incidence of new-onset DM or its progression [54]. However, a small association between ICS use and the presence of T2DM with the occurrence of hyperglycaemia in susceptible individuals has been reported in the literature [6].…”

Section: Potential Impact On T2dm Of Drugs Used To Treat Copdmentioning

confidence: 99%

Hyperglycaemia and Chronic Obstructive Pulmonary Disease

Cazzola,

Rogliani,

Ora

et al. 2023

Diagnostics

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Chronic obstructive pulmonary disease (COPD) may coexist with type 2 diabetes mellitus (T2DM). Patients with COPD have an increased risk of developing T2DM compared with a control but, on the other side, hyperglycaemia and DM have been associated with reduced predicted levels of lung function. The mechanistic relationships between these two diseases are complicated, multifaceted, and little understood, yet they can impact treatment strategy. The potential risks and benefits for patients with T2DM treated with pulmonary drugs and the potential pulmonary risks and benefits for patients with COPD when taking antidiabetic drugs should always be considered. The interaction between the presence and/or treatment of COPD, risk of infection, presence and/or treatment of T2DM and risk of acute exacerbations of COPD (AECOPDs) can be represented as a vicious circle; however, several strategies may help to break this circle. The most effective approach to simultaneously treating T2DM and COPD is to interfere with the shared inflammatory substrate, thus targeting both lung inflammation (COPD) and vascular inflammation (DM). In any case, it is always crucial to establish glycaemic management since the reduction in lung function found in people with diabetes might decrease the threshold for clinical manifestations of COPD. In this article, we examine possible connections between COPD and T2DM as well as pharmacological strategies that could focus on these connections.

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Association between ICS use and risk of hyperglycemia in COPD patients: systematic review and meta-analysis

Cited by 8 publications

References 34 publications

STOP: an open label crossover trial to study ICS withdrawal in patients with a combination of obesity and low-inflammatory asthma and evaluate its effect on asthma control and quality of life

STOP: an open label crossover trial to study ICS withdrawal in patients with a combination of obesity and low-inflammatory asthma and evaluate its effect on asthma control and quality of life

Cardiovascular diseases or type 2 diabetes mellitus and chronic airway diseases: mutual pharmacological interferences

Hyperglycaemia and Chronic Obstructive Pulmonary Disease

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