Conflict of interest statement: The Medical Research Institute of New Zealand has received research grants from AstraZeneca and GlaxoSmithKline, which manufacture ICS products, and from Novartis, which manufactures non-ICS products, used in the treatment of asthma and COPD. R.B. has received fees for consulting and speaking from AstraZeneca, GlaxoSmithKline and Novartis.
Dose–response relationship of inhaled corticosteroids and cataracts: A systematic review and meta-analysis
Article first published online: 2 AUG 2009
© 2009 The Authors. Journal compilation © 2009 Asian Pacific Society of Respirology
Volume 14, Issue 7, pages 983–990, September 2009
How to Cite
WEATHERALL, M., CLAY, J., JAMES, K., PERRIN, K., SHIRTCLIFFE, P. and BEASLEY, R. (2009), Dose–response relationship of inhaled corticosteroids and cataracts: A systematic review and meta-analysis. Respirology, 14: 983–990. doi: 10.1111/j.1440-1843.2009.01589.x
- Issue published online: 2 SEP 2009
- Article first published online: 2 AUG 2009
- Received 9 November 2008; invited to revise 25 December 2008; revised 1 February 2009; accepted 18 February 2009 (Associate Editor: Helen Reddel).
- inhaled corticosteroid
Background and objective: The risk of cataracts associated with the long-term use of inhaled corticosteroids (ICS) is poorly recognized, yet may be of major public health importance. The aim of this study was to determine the dose–response relationship of ICS use and risk of cataracts in adults.
Methods: A systematic review and meta-analysis was performed of case–control studies of cataracts and ICS use, which included at least two doses of ICS and in which the number of cases and controls using each dose of ICS was reported. The primary outcome variable was risk of cataracts.
Results: Four case–control studies were identified, with a total of 46 638 cases and 146 378 controls. There was a significant relationship between the risk of cataracts and ICS dose, with a random effects pooled odds ratio for risk of cataracts per 1000 µg increase in daily beclomethasone dipropionate dose of 1.25 (95% CI: 1.14–1.37).
Conclusions: The risk of cataracts was increased by approximately 25% for each 1000 µg per day increase in the dose of beclomethasone dipropionate or equivalent. These findings reinforce the importance of prescribing within the therapeutic dose–response range for ICS in asthma and the need to determine the dose–response relationship for the efficacy of ICS in COPD. Screening for the presence of cataracts could usefully be undertaken in older subjects with asthma and COPD, particularly current or ex-smokers.