Are inhaled corticosteroids protective against lung cancer in COPD patients? Results of a retrospective analysis from Hungary

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Background: Lung cancer (LC) is one of the main causes of death among COPD patients. Similar risk factors and pathophysiology stemmed multiple retrospective researches investigating a possible risk reduction effect of inhaled corticosteroid (ICS) use among COPD patients, yet there is still no consensus on the issue. Methods: Using the financial database of the National Health Insurance Fund, involving the overall population of Hungary, two retrospective analyses were performed between 2009-’19, based on the contradicting works of Suissa (Suissa et al. Eur. Respir J. 2020 Feb 20;55(2):1901720) and Raymakers (Raymakers et al. Eur. Respir J. 2019 53(6): 1801257). Both study methods were used to recreate the study populations and compare the outcomes. Cox proportional hazard models were used to estimate the effect of ICS use on the risk of LC. The models were corrected for immortal time bias. Results: Altogether 196,560 and 96,686 patients were enrolled in the Raymakers and Suissa models respectively. Average age were 65.3 (standard deviation – SD: 9.37) and 65.7 (SD: 9.14) years with 56% and 48.4% of all patients being female. Through the study period 60.8% and 26.2% used ICS for longer than 1 year. Overall 8,969 and 4,941 new LC cases were identified. Based on the adjusted Cox models ICS use had a protective effect in both populations with hazard ratios being 0.58 (0.54-0.61) and 0.7 (0.7-0.85) respectively. Conclusions: Even though the original publications reported contradicting result, in our analysis of more than 200,000 COPD patients, both the models of Raymakers and Suissa showed a significant reduction of LC risk in COPD patients using ICS therapies.

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