Table 4.
Effect of ICS therapy on COPD mortality in non-randomized cohort studies
| Source of data | Comparison | Risk of death (95% CI) | Summary of outcome |
|---|---|---|---|
| (Sin and Tu 2001) | ICS vs no ICS | 0.71 (0.65, 0.78) | Significant survival benefit with ICS |
| (Soriano et al 2002) | FP + salmeterol vs no ICS or LABA | 0.48 (0.31, 0.73) | Significant survival benefit with FP and salmeterol |
| FP alone vs no ICS or LABA | 0.62 (0.45, 0.85) | Significant survival benefit with FP alone | |
| Salmeterol alone vs no ICS or LABA | 0.79 (0.58, 1.07) | Significant survival benefit with salmeterol alone | |
| (Soriano et al 2003)b | ICS + LABA | 10.5% | Reduction in risk of rehospitalization or death with ICS and/or LABA |
| ICS alone | 17.1% | ||
| LABA alone | 17.3% | ||
| SABA alone | 24.3% | ||
| (Sin and Man 2003a) | ICS vs no ICS | 0.75 (0.68, 0.82) | Significant survival benefit with ICS overall, and especially for medium- to high-dose ICS |
| Low-dosea ICS vs no ICS | 0.77 (0.69, 0.86) | ||
| Medium-dosea ICS vs no ICS | 0.48 (0.37, 0.63) | ||
| High-dosea ICS vs no ICS | 0.55 (0.44, 0.69) | ||
| (Suissa 2003) | ICS vs no ICS | 0.69 (0.55, 0.86) | No reduction in morbidity or mortality with ICS (after controlling for time dependence) |
| Time fixed adjusted rate | |||
| ICS vs no ICS | 1.00 (0.79, 1.26) | ||
| Time dependent rate | |||
| (Suissa 2004) | ICS vs bronchodilators | 0.66 (0.57, 0.76) | No reduction in all-cause mortality with ICS |
| (Fan et al 2003) | Low-dose ICS vs no ICS | 0.75 (0.53, 1.05) | No reduction in mortality or exacerbations with ICS |
| Medium-/high-dose ICS vs no ICS | 0.91 (0.73, 1.13) | ||
| (Kiri et al 2005b) | ICS vs no ICS | 0.69 (0.052, 0.93) | Survival benefit with ICS (in both models) |
| propensity scores | |||
| ICS vs no ICS | 0.71 (0.56, 0.90) | ||
| nested case control |
a
Dose was converted to beclomethasone equivalents and classified as low (≤ 500 μg/day), medium (501–1000 μg/day), and high (>1000 μg/day).
b
This study reported one-year mortality rates.
Abbreviations: CI, confidence interval; FP, fluticasone propionate; ICS, inhaled corticosteroids; LABA, long-acting β2-agonists; NS, not significant.