Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids: Effect of drug, dose, and device

P.N. Richard Dekhuijzen, Maria Batsiou, Leif Bjermer, Sinthia Bosnic-Anticevich, Henry Chrystyn, Alberto Papi, Roberto Rodriguez-Roisin, Monica Fletcher, Lucy Wood, Alessandra Cifra, Joan B Soriano, David B. Price

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Abstract

Background and aims

Little information is available on real-life occurrence of oral thrush in COPD patients treated with ICS. We investigated oral thrush incidence in COPD patients prescribed FDC ICS/LABA therapies and assessed whether it is modulated by the ICS type, dose, and delivery device.

Methods

We conducted a historical, observational, matched cohort study (one baseline year before and one outcome year after initiation of therapy) using data from the UK Optimum Patient Care Research Database. We assessed oral thrush incidence in patients initiating long-acting bronchodilators or FDC ICS/LABA therapy. We then compared different combination therapies (budesonide/formoterol fumarate dihydrate [BUD/FOR] and fluticasone propionate/salmeterol xinafoate [FP/SAL]) and devices (DPI and pMDI).

Results

Patients prescribed FDC ICS/LABA had significantly greater odds of experiencing oral thrush than those prescribed long-acting bronchodilators alone (adjusted OR 2.18 [95% CI 1.84–2.59]). Significantly fewer patients prescribed BUD/FOR DPI developed oral thrush compared with FP/SAL DPI (OR 0.77 [0.63–0.94]) when allowing for differences in prescribed doses between the drugs. A significantly smaller proportion of patients developed oral thrush in the FP/SAL pMDI arm than in the FP/SAL DPI arm (OR 0.67 [0.55–0.82]). Additionally, in the FP/SAL cohort (both DPI and pMDI), increased risk of oral thrush was significantly associated with high ICS daily dose (OR 1.97 [1.22–3.17] vs low daily dose).

Conclusions

ICS use increases oral thrush incidence in COPD and this effect is dose-dependent for FP/SAL therapies. Of the therapies assessed, FP/SAL pMDI and BUD/FOR DPI may be more protective against oral thrush.
Original languageEnglish
Pages (from-to)54-63
Number of pages10
JournalRespiratory Medicine
Volume120
Early online date22 Sep 2016
DOIs
Publication statusPublished - Nov 2016

Fingerprint

Oral Candidiasis
Chronic Obstructive Pulmonary Disease
Adrenal Cortex Hormones
Equipment and Supplies
Incidence
Pharmaceutical Preparations
Budesonide
Bronchodilator Agents
Therapeutics
Salmeterol Xinafoate Drug Combination Fluticasone Propionate
Patient Care
Cohort Studies
Databases

Keywords

  • oral candidiasis
  • chronic obstructive pulmonary disease
  • inhaled corticosteroid
  • spacer
  • dry powder inhaler
  • pressurised metered-dose inhaler

Cite this

Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids : Effect of drug, dose, and device. / Dekhuijzen, P.N. Richard ; Batsiou, Maria ; Bjermer, Leif; Bosnic-Anticevich, Sinthia; Chrystyn, Henry; Papi, Alberto; Rodriguez-Roisin, Roberto; Fletcher, Monica; Wood, Lucy; Cifra, Alessandra; Soriano, Joan B; Price, David B.

In: Respiratory Medicine, Vol. 120, 11.2016, p. 54-63.

Research output: Contribution to journalArticle

Dekhuijzen, PNR, Batsiou, M, Bjermer, L, Bosnic-Anticevich, S, Chrystyn, H, Papi, A, Rodriguez-Roisin, R, Fletcher, M, Wood, L, Cifra, A, Soriano, JB & Price, DB 2016, 'Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids: Effect of drug, dose, and device', Respiratory Medicine, vol. 120, pp. 54-63. https://doi.org/10.1016/j.rmed.2016.09.015
Dekhuijzen, P.N. Richard ; Batsiou, Maria ; Bjermer, Leif ; Bosnic-Anticevich, Sinthia ; Chrystyn, Henry ; Papi, Alberto ; Rodriguez-Roisin, Roberto ; Fletcher, Monica ; Wood, Lucy ; Cifra, Alessandra ; Soriano, Joan B ; Price, David B. / Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids : Effect of drug, dose, and device. In: Respiratory Medicine. 2016 ; Vol. 120. pp. 54-63.
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title = "Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids: Effect of drug, dose, and device",
abstract = "Background and aimsLittle information is available on real-life occurrence of oral thrush in COPD patients treated with ICS. We investigated oral thrush incidence in COPD patients prescribed FDC ICS/LABA therapies and assessed whether it is modulated by the ICS type, dose, and delivery device.MethodsWe conducted a historical, observational, matched cohort study (one baseline year before and one outcome year after initiation of therapy) using data from the UK Optimum Patient Care Research Database. We assessed oral thrush incidence in patients initiating long-acting bronchodilators or FDC ICS/LABA therapy. We then compared different combination therapies (budesonide/formoterol fumarate dihydrate [BUD/FOR] and fluticasone propionate/salmeterol xinafoate [FP/SAL]) and devices (DPI and pMDI).ResultsPatients prescribed FDC ICS/LABA had significantly greater odds of experiencing oral thrush than those prescribed long-acting bronchodilators alone (adjusted OR 2.18 [95{\%} CI 1.84–2.59]). Significantly fewer patients prescribed BUD/FOR DPI developed oral thrush compared with FP/SAL DPI (OR 0.77 [0.63–0.94]) when allowing for differences in prescribed doses between the drugs. A significantly smaller proportion of patients developed oral thrush in the FP/SAL pMDI arm than in the FP/SAL DPI arm (OR 0.67 [0.55–0.82]). Additionally, in the FP/SAL cohort (both DPI and pMDI), increased risk of oral thrush was significantly associated with high ICS daily dose (OR 1.97 [1.22–3.17] vs low daily dose).ConclusionsICS use increases oral thrush incidence in COPD and this effect is dose-dependent for FP/SAL therapies. Of the therapies assessed, FP/SAL pMDI and BUD/FOR DPI may be more protective against oral thrush.",
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author = "Dekhuijzen, {P.N. Richard} and Maria Batsiou and Leif Bjermer and Sinthia Bosnic-Anticevich and Henry Chrystyn and Alberto Papi and Roberto Rodriguez-Roisin and Monica Fletcher and Lucy Wood and Alessandra Cifra and Soriano, {Joan B} and Price, {David B.}",
note = "The authors wish to thank Derek Skinner for his assistance with data extraction and analysis. Rafael Mares and Bakhtiyor Khalikulov are particularly thanked for assistance with study design and data extraction during the preliminary phase of the study. This study was conducted by Research in Real Life Ltd, under a subcontract by Observational and Pragmatic Research Institute Pte Ltd, with institutional support from Teva Pharmaceuticals Europe B.V.",
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TY - JOUR

T1 - Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids

T2 - Effect of drug, dose, and device

AU - Dekhuijzen, P.N. Richard

AU - Batsiou, Maria

AU - Bjermer, Leif

AU - Bosnic-Anticevich, Sinthia

AU - Chrystyn, Henry

AU - Papi, Alberto

AU - Rodriguez-Roisin, Roberto

AU - Fletcher, Monica

AU - Wood, Lucy

AU - Cifra, Alessandra

AU - Soriano, Joan B

AU - Price, David B.

N1 - The authors wish to thank Derek Skinner for his assistance with data extraction and analysis. Rafael Mares and Bakhtiyor Khalikulov are particularly thanked for assistance with study design and data extraction during the preliminary phase of the study. This study was conducted by Research in Real Life Ltd, under a subcontract by Observational and Pragmatic Research Institute Pte Ltd, with institutional support from Teva Pharmaceuticals Europe B.V.

PY - 2016/11

Y1 - 2016/11

N2 - Background and aimsLittle information is available on real-life occurrence of oral thrush in COPD patients treated with ICS. We investigated oral thrush incidence in COPD patients prescribed FDC ICS/LABA therapies and assessed whether it is modulated by the ICS type, dose, and delivery device.MethodsWe conducted a historical, observational, matched cohort study (one baseline year before and one outcome year after initiation of therapy) using data from the UK Optimum Patient Care Research Database. We assessed oral thrush incidence in patients initiating long-acting bronchodilators or FDC ICS/LABA therapy. We then compared different combination therapies (budesonide/formoterol fumarate dihydrate [BUD/FOR] and fluticasone propionate/salmeterol xinafoate [FP/SAL]) and devices (DPI and pMDI).ResultsPatients prescribed FDC ICS/LABA had significantly greater odds of experiencing oral thrush than those prescribed long-acting bronchodilators alone (adjusted OR 2.18 [95% CI 1.84–2.59]). Significantly fewer patients prescribed BUD/FOR DPI developed oral thrush compared with FP/SAL DPI (OR 0.77 [0.63–0.94]) when allowing for differences in prescribed doses between the drugs. A significantly smaller proportion of patients developed oral thrush in the FP/SAL pMDI arm than in the FP/SAL DPI arm (OR 0.67 [0.55–0.82]). Additionally, in the FP/SAL cohort (both DPI and pMDI), increased risk of oral thrush was significantly associated with high ICS daily dose (OR 1.97 [1.22–3.17] vs low daily dose).ConclusionsICS use increases oral thrush incidence in COPD and this effect is dose-dependent for FP/SAL therapies. Of the therapies assessed, FP/SAL pMDI and BUD/FOR DPI may be more protective against oral thrush.

AB - Background and aimsLittle information is available on real-life occurrence of oral thrush in COPD patients treated with ICS. We investigated oral thrush incidence in COPD patients prescribed FDC ICS/LABA therapies and assessed whether it is modulated by the ICS type, dose, and delivery device.MethodsWe conducted a historical, observational, matched cohort study (one baseline year before and one outcome year after initiation of therapy) using data from the UK Optimum Patient Care Research Database. We assessed oral thrush incidence in patients initiating long-acting bronchodilators or FDC ICS/LABA therapy. We then compared different combination therapies (budesonide/formoterol fumarate dihydrate [BUD/FOR] and fluticasone propionate/salmeterol xinafoate [FP/SAL]) and devices (DPI and pMDI).ResultsPatients prescribed FDC ICS/LABA had significantly greater odds of experiencing oral thrush than those prescribed long-acting bronchodilators alone (adjusted OR 2.18 [95% CI 1.84–2.59]). Significantly fewer patients prescribed BUD/FOR DPI developed oral thrush compared with FP/SAL DPI (OR 0.77 [0.63–0.94]) when allowing for differences in prescribed doses between the drugs. A significantly smaller proportion of patients developed oral thrush in the FP/SAL pMDI arm than in the FP/SAL DPI arm (OR 0.67 [0.55–0.82]). Additionally, in the FP/SAL cohort (both DPI and pMDI), increased risk of oral thrush was significantly associated with high ICS daily dose (OR 1.97 [1.22–3.17] vs low daily dose).ConclusionsICS use increases oral thrush incidence in COPD and this effect is dose-dependent for FP/SAL therapies. Of the therapies assessed, FP/SAL pMDI and BUD/FOR DPI may be more protective against oral thrush.

KW - oral candidiasis

KW - chronic obstructive pulmonary disease

KW - inhaled corticosteroid

KW - spacer

KW - dry powder inhaler

KW - pressurised metered-dose inhaler

U2 - 10.1016/j.rmed.2016.09.015

DO - 10.1016/j.rmed.2016.09.015

M3 - Article

VL - 120

SP - 54

EP - 63

JO - Respiratory Medicine

JF - Respiratory Medicine

SN - 0954-6111

ER -