TY - JOUR
T1 - Regular inhaled corticosteroids in adult-onset asthma and the risk for future cancer
T2 - A population-based cohort study with proper person-time analysis
AU - Kok, Victor C.
AU - Horng, Jorng Tzong
AU - Huang, Hsu Kai
AU - Chao, Tsung Ming
AU - Hong, Ya Fang
N1 - Publisher Copyright:
© 2015 Kok et al.
PY - 2015/3/26
Y1 - 2015/3/26
N2 - Background: Recent studies have shown that inhaled corticosteroids (ICS) can exert anti-infammatory effects for chronic airway diseases, and several observational studies suggest that they play a role as cancer chemopreventive agents, particularly against lung cancer. We aimed to examine whether regular ICS use was associated with a reduced risk for future malignancy in patients with newly diagnosed adult-onset asthma. Methods: We used a population-based cohort study between 2001 and 2008 with appropriate person-time analysis. Participants were followed up until the frst incident of cancer, death, or to the end of 2008. The Cox model was used to derive an adjusted hazard ratio (aHR) for cancer development. Kaplan–Meier cancer-free survival curves of two groups were compared. Results: The exposed group of 2,117 regular ICS users and the nonexposed group of 17,732 non-ICS users were assembled. After 7,365 (mean, 3.5 years; standard deviation 2.1) and 73,789 (mean, 4.1 years; standard deviation 2.4) person-years of follow-up for the ICS users and the comparator group of non-ICS users, respectively, the aHR for overall cancer was nonsignif-cantly elevated at 1.33 with 95% confdence interval (CI), 1.00–1.76, P=0.0501. The Kaplan– Meier curves for overall cancer-free proportions of both groups were not signifcant (log-rank, P=0.065). Synergistic interaction of concurrent presence of regular ICS use was conducted using “ICS-negative and chronic obstructive pulmonary disease (COPD)-negative” as the reference. The aHR for the group of “ICS-positive, COPD-negative” did not reach statistically signifcant levels with aHR at 1.38 (95% CI, 0.53–3.56). There was a statistically signifcant synergistic interaction of concurrent presence of regular ICS use and COPD with aHR at 3.78 (95% CI, 2.10–6.81). Conclusion: The protective effect of regular ICS use in the studied East Asian patients with adult-onset asthma was not detectable, contrary to reports of previous studies that ICS might prevent the occurrence of future cancer.
AB - Background: Recent studies have shown that inhaled corticosteroids (ICS) can exert anti-infammatory effects for chronic airway diseases, and several observational studies suggest that they play a role as cancer chemopreventive agents, particularly against lung cancer. We aimed to examine whether regular ICS use was associated with a reduced risk for future malignancy in patients with newly diagnosed adult-onset asthma. Methods: We used a population-based cohort study between 2001 and 2008 with appropriate person-time analysis. Participants were followed up until the frst incident of cancer, death, or to the end of 2008. The Cox model was used to derive an adjusted hazard ratio (aHR) for cancer development. Kaplan–Meier cancer-free survival curves of two groups were compared. Results: The exposed group of 2,117 regular ICS users and the nonexposed group of 17,732 non-ICS users were assembled. After 7,365 (mean, 3.5 years; standard deviation 2.1) and 73,789 (mean, 4.1 years; standard deviation 2.4) person-years of follow-up for the ICS users and the comparator group of non-ICS users, respectively, the aHR for overall cancer was nonsignif-cantly elevated at 1.33 with 95% confdence interval (CI), 1.00–1.76, P=0.0501. The Kaplan– Meier curves for overall cancer-free proportions of both groups were not signifcant (log-rank, P=0.065). Synergistic interaction of concurrent presence of regular ICS use was conducted using “ICS-negative and chronic obstructive pulmonary disease (COPD)-negative” as the reference. The aHR for the group of “ICS-positive, COPD-negative” did not reach statistically signifcant levels with aHR at 1.38 (95% CI, 0.53–3.56). There was a statistically signifcant synergistic interaction of concurrent presence of regular ICS use and COPD with aHR at 3.78 (95% CI, 2.10–6.81). Conclusion: The protective effect of regular ICS use in the studied East Asian patients with adult-onset asthma was not detectable, contrary to reports of previous studies that ICS might prevent the occurrence of future cancer.
KW - Immortal time bias
KW - NHIRD
KW - Population-based study
KW - Retrospective cohort study
KW - Risk of cancer
UR - http://www.scopus.com/inward/record.url?scp=84928166919&partnerID=8YFLogxK
U2 - 10.2147/TCRM.S80793
DO - 10.2147/TCRM.S80793
M3 - 期刊論文
AN - SCOPUS:84928166919
SN - 1176-6336
VL - 11
SP - 489
EP - 499
JO - Therapeutics and Clinical Risk Management
JF - Therapeutics and Clinical Risk Management
ER -