Thiazolidinediones are associated with a reduced risk of COPD exacerbations

Abstract

Seppo T Rinne,1,2 Chuan-Fen Liu,3,4 Laura C Feemster,3,5 Bridget F Collins,3,5 Christopher L Bryson,3,6 Thomas G O’Riordan,7 David H Au3,4 1Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, 2Division of Pulmonary and Critical Care, Yale University, New Haven, CT, USA; 3VA Puget Sound Health Care System, Department of Veterans Affairs, 4Department of Health Services, University of Washington, 5Division of Pulmonary and Critical Care, University of Washington, 6Division of General Internal Medicine, University of Washington, 7Gilead Sciences, Inc., Seattle, WA, USA Background: Thiazolidinediones (TZDs) are oral antihyperglycemic medications that are selective agonists to peroxisome proliferator-activated receptor gamma and have been shown to have potent anti-inflammatory effects in the lung.Objective: The purpose of this study was to assess whether exposure to TZDs is associated with a decreased risk of chronic obstructive pulmonary disease (COPD) exacerbation.Methods: A cohort study was performed by collecting data on all US veterans with diabetes and COPD who were prescribed oral antihyperglycemic medications during from period of October 1, 2005 to September 30, 2007. Patients who had two or more prescriptions for TZDs were compared with patients who had two or more prescriptions for an alternative oral antihyperglycemic medication. Multivariable negative binomial regression was performed with adjustment for potential confounding factors. The primary outcome was COPD exacerbations, including both inpatient and outpatient exacerbations.Results: We identified 7,887 veterans who were exposed to TZD and 42,347 veterans who were exposed to non-TZD oral diabetes medications. COPD exacerbations occurred in 1,258 (16%) of the TZD group and 7,789 (18%) of the non-TZD group. In multivariable negative binomial regression, there was a significant reduction in the expected number of COPD exacerbations among patients who were exposed to TZDs with an incidence rate ratio of 0.86 (95% CI 0.81–0.92).Conclusion: Exposure to TZDs was associated with a small but significant reduction in risk for COPD exacerbation among diabetic patients with COPD. Keywords: peroxisome proliferator-activated receptors, glitazones, COPD exacerbation, inflammation, cohort study