二甲双胍的使用与哮喘急性发作风险的关系，一项基于索赔的队列研究
2020/01/07
摘要
理由：糖尿病及代谢综合征与哮喘控制不佳具有相关性。二甲双胍可改善胰岛素抵抗及代谢功能。实验研究表明，二甲双胍可以改善哮喘的病理特征，但临床获益的证据有限。
目标：确定哮喘与糖尿病人群中使用二甲双胍是否与哮喘急性发作风险较低相关。
方法：从国家行政理赔数据库中收集18岁以上的哮喘和糖尿病患者，并对其进行为期6年的回顾性研究。根据人口统计学、合并症和用药特征，通过倾向评分对首次二甲双胍使用者与未使用者进行匹配。急性发作定义为与哮喘相关的住院、急诊就诊或哮喘门诊就诊后14天内开具全身激素处方。利用Cox比例危险模型估测哮喘急性发作的变化与二甲双胍使用的关系。
结果：在23920位哮喘和糖尿病人群中，二甲双胍的使用与哮喘急性发作低风险相关（HR, 0.92; 95% CI, 0.86-0.98)，这是由与哮喘相关的急诊就诊(HR, 0.81; 95% CI, 0.74-0.88)和住院(HR, 0.67; 95% CI, 0.50-0.91)的低风险所致，而激素的使用(HR, 0.96; 95% CI, 0.86-1.03)无差异。
结论：在哮喘和糖尿病人群中，使用二甲双胍与哮喘导致的急诊就诊及住院低发生率相关。这些发现表明二甲双胍可能在较重的哮喘急性发作中获益。对于研究队列中受试者进行更详细的特征调查是必要的。
Association of Metformin Initiation and Risk of Asthma Exacerbation. A Claims-based Cohort Study.
Wu TD, Keet CA, Fawzy A, Segal JB, Brigham EP, McCormack MC.
Abstract
Rationale: Diabetes and metabolic syndrome have been associated with worsened asthma control.
Metformin improves insulin resistance and metabolic function. Experimental studies suggest that metformin may improve pathologic features of asthma, but evidence of clinical benefit is limited.
Objectives: To determine if treatment with metformin in a cohort of individuals with asthma and diabetes is associated with lower risk of asthma exacerbation.
Methods:A 6-year retrospective cohort of individuals over age 18 with asthma and diabetes was assembled from a national administrative claims database. New users of metformin were matched to nonusers by propensity score on the basis of demographic, comorbidity, and medication-use characteristics. An exacerbation was defined as an asthma-related hospitalization, emergency department visit, or filling of a systemic corticosteroid prescription within 14 days of an asthma-related ambulatory visit. Cox proportional hazards estimated the change in hazard of asthma exacerbation associated with metformin initiation.
Results: In a cohort of 23,920 individuals with asthma and diabetes, metformin initiation was associated with lower hazard of asthma exacerbation (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.86-0.98), driven by lower hazards of asthma-related emergency department visits (HR, 0.81; 95% CI, 0.74-0.88) and hospitalization (HR, 0.67; 95% CI, 0.50-0.91), without differences in corticosteroid use (HR, 0.96; 95% CI, 0.86-1.03).
Conclusions:In an administrative cohort of individuals with asthma and diabetes, metformin initiation
was associated with a lower hazard of asthma-related emergency department visits and hospitalizations. These findings suggest a possible benefit of metformin in more severe asthma exacerbations. Investigation within cohorts with more detailed participant characterization is necessary.
理由：糖尿病及代谢综合征与哮喘控制不佳具有相关性。二甲双胍可改善胰岛素抵抗及代谢功能。实验研究表明，二甲双胍可以改善哮喘的病理特征，但临床获益的证据有限。
目标：确定哮喘与糖尿病人群中使用二甲双胍是否与哮喘急性发作风险较低相关。
方法：从国家行政理赔数据库中收集18岁以上的哮喘和糖尿病患者，并对其进行为期6年的回顾性研究。根据人口统计学、合并症和用药特征，通过倾向评分对首次二甲双胍使用者与未使用者进行匹配。急性发作定义为与哮喘相关的住院、急诊就诊或哮喘门诊就诊后14天内开具全身激素处方。利用Cox比例危险模型估测哮喘急性发作的变化与二甲双胍使用的关系。
结果：在23920位哮喘和糖尿病人群中，二甲双胍的使用与哮喘急性发作低风险相关（HR, 0.92; 95% CI, 0.86-0.98)，这是由与哮喘相关的急诊就诊(HR, 0.81; 95% CI, 0.74-0.88)和住院(HR, 0.67; 95% CI, 0.50-0.91)的低风险所致，而激素的使用(HR, 0.96; 95% CI, 0.86-1.03)无差异。
结论：在哮喘和糖尿病人群中，使用二甲双胍与哮喘导致的急诊就诊及住院低发生率相关。这些发现表明二甲双胍可能在较重的哮喘急性发作中获益。对于研究队列中受试者进行更详细的特征调查是必要的。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（Ann Am Thorac Soc. 2019 Dec;16(12):1527-1533.）
（Ann Am Thorac Soc. 2019 Dec;16(12):1527-1533.）
Association of Metformin Initiation and Risk of Asthma Exacerbation. A Claims-based Cohort Study.
Wu TD, Keet CA, Fawzy A, Segal JB, Brigham EP, McCormack MC.
Abstract
Rationale: Diabetes and metabolic syndrome have been associated with worsened asthma control.
Metformin improves insulin resistance and metabolic function. Experimental studies suggest that metformin may improve pathologic features of asthma, but evidence of clinical benefit is limited.
Objectives: To determine if treatment with metformin in a cohort of individuals with asthma and diabetes is associated with lower risk of asthma exacerbation.
Methods:A 6-year retrospective cohort of individuals over age 18 with asthma and diabetes was assembled from a national administrative claims database. New users of metformin were matched to nonusers by propensity score on the basis of demographic, comorbidity, and medication-use characteristics. An exacerbation was defined as an asthma-related hospitalization, emergency department visit, or filling of a systemic corticosteroid prescription within 14 days of an asthma-related ambulatory visit. Cox proportional hazards estimated the change in hazard of asthma exacerbation associated with metformin initiation.
Results: In a cohort of 23,920 individuals with asthma and diabetes, metformin initiation was associated with lower hazard of asthma exacerbation (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.86-0.98), driven by lower hazards of asthma-related emergency department visits (HR, 0.81; 95% CI, 0.74-0.88) and hospitalization (HR, 0.67; 95% CI, 0.50-0.91), without differences in corticosteroid use (HR, 0.96; 95% CI, 0.86-1.03).
Conclusions:In an administrative cohort of individuals with asthma and diabetes, metformin initiation
was associated with a lower hazard of asthma-related emergency department visits and hospitalizations. These findings suggest a possible benefit of metformin in more severe asthma exacerbations. Investigation within cohorts with more detailed participant characterization is necessary.
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