Risk of incident active tuberculosis disease in patients treated with non-steroidal anti-inflammatory drugs

A population-based study

Chun Wei Wu, Jiunn Yih Wu, Meng Tse Gabriel Lee, Chih Cheng Lai, I. Lin Wu, Yi Wen Tsai, Shy Shin Chang, Chien Chang Lee

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Mycobacterium tuberculosis (TB) is one of the world's most devastating public health threats. Our goal is to evaluate whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) affect the risk of new incident active TB disease. Methods: We conducted a nested case-control analysis by using a 1 million longitudinally followed cohort, from Taiwan's national health insurance research database. Effects of NSAIDs on active TB were estimated by conditional logistic regression and adjusted using a TB-specific disease risk score (DRS). NSAIDs exposures were defined as having a prescription record of NSAIDs 7 days that ended between 31 and 90 days prior to the index date. Results: A total of 123,419 users of traditional NSAIDs, 16,392 users of cyclooxygenase-2 selective inhibitor (Coxibs), and 4706 incident cases of active TB were identified. Compared with nonusers, use of traditional NSAIDs was associated with an increased risk of TB in the unadjusted analysis ([RR], 1.39; 95% [CI], 1.24 - 1.57 and DRS adjusted analysis ([ARR], 1.30; 95% [CI], 1.15- 1.47). However, use of Coxibs was not associated with a significant increase in the risk of TB after DRS adjustment ([ARR], 1.23; 95% [CI], 0.89 - 1.70). Conclusions: In this large population-based study, we found that subjects using traditional NSAIDs were associated with increased risk for active TB. We did not find evidence for a causative mechanism between traditional NSAIDs and TB, and more research is required to verify whether the association between traditional NSAIDs and TB is causal, or simply reflects an increased use of anti-inflammatory drugs in the early phases of TB onset.

Original languageEnglish
Article number82
JournalBMC Pulmonary Medicine
Volume17
Issue number1
DOIs
Publication statusPublished - May 4 2017

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Tuberculosis
Anti-Inflammatory Agents
Pharmaceutical Preparations
Population
Cyclooxygenase 2 Inhibitors
Risk Adjustment
National Health Programs
Taiwan
Mycobacterium tuberculosis
Research
Prescriptions
Public Health
Logistic Models
Databases

Keywords

  • Coxibs
  • NSAIDs
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Risk of incident active tuberculosis disease in patients treated with non-steroidal anti-inflammatory drugs : A population-based study. / Wu, Chun Wei; Wu, Jiunn Yih; Lee, Meng Tse Gabriel; Lai, Chih Cheng; Wu, I. Lin; Tsai, Yi Wen; Chang, Shy Shin; Lee, Chien Chang.

In: BMC Pulmonary Medicine, Vol. 17, No. 1, 82, 04.05.2017.

Research output: Contribution to journalArticle

Wu, Chun Wei ; Wu, Jiunn Yih ; Lee, Meng Tse Gabriel ; Lai, Chih Cheng ; Wu, I. Lin ; Tsai, Yi Wen ; Chang, Shy Shin ; Lee, Chien Chang. / Risk of incident active tuberculosis disease in patients treated with non-steroidal anti-inflammatory drugs : A population-based study. In: BMC Pulmonary Medicine. 2017 ; Vol. 17, No. 1.
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abstract = "Background: Mycobacterium tuberculosis (TB) is one of the world's most devastating public health threats. Our goal is to evaluate whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) affect the risk of new incident active TB disease. Methods: We conducted a nested case-control analysis by using a 1 million longitudinally followed cohort, from Taiwan's national health insurance research database. Effects of NSAIDs on active TB were estimated by conditional logistic regression and adjusted using a TB-specific disease risk score (DRS). NSAIDs exposures were defined as having a prescription record of NSAIDs 7 days that ended between 31 and 90 days prior to the index date. Results: A total of 123,419 users of traditional NSAIDs, 16,392 users of cyclooxygenase-2 selective inhibitor (Coxibs), and 4706 incident cases of active TB were identified. Compared with nonusers, use of traditional NSAIDs was associated with an increased risk of TB in the unadjusted analysis ([RR], 1.39; 95{\%} [CI], 1.24 - 1.57 and DRS adjusted analysis ([ARR], 1.30; 95{\%} [CI], 1.15- 1.47). However, use of Coxibs was not associated with a significant increase in the risk of TB after DRS adjustment ([ARR], 1.23; 95{\%} [CI], 0.89 - 1.70). Conclusions: In this large population-based study, we found that subjects using traditional NSAIDs were associated with increased risk for active TB. We did not find evidence for a causative mechanism between traditional NSAIDs and TB, and more research is required to verify whether the association between traditional NSAIDs and TB is causal, or simply reflects an increased use of anti-inflammatory drugs in the early phases of TB onset.",
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AB - Background: Mycobacterium tuberculosis (TB) is one of the world's most devastating public health threats. Our goal is to evaluate whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) affect the risk of new incident active TB disease. Methods: We conducted a nested case-control analysis by using a 1 million longitudinally followed cohort, from Taiwan's national health insurance research database. Effects of NSAIDs on active TB were estimated by conditional logistic regression and adjusted using a TB-specific disease risk score (DRS). NSAIDs exposures were defined as having a prescription record of NSAIDs 7 days that ended between 31 and 90 days prior to the index date. Results: A total of 123,419 users of traditional NSAIDs, 16,392 users of cyclooxygenase-2 selective inhibitor (Coxibs), and 4706 incident cases of active TB were identified. Compared with nonusers, use of traditional NSAIDs was associated with an increased risk of TB in the unadjusted analysis ([RR], 1.39; 95% [CI], 1.24 - 1.57 and DRS adjusted analysis ([ARR], 1.30; 95% [CI], 1.15- 1.47). However, use of Coxibs was not associated with a significant increase in the risk of TB after DRS adjustment ([ARR], 1.23; 95% [CI], 0.89 - 1.70). Conclusions: In this large population-based study, we found that subjects using traditional NSAIDs were associated with increased risk for active TB. We did not find evidence for a causative mechanism between traditional NSAIDs and TB, and more research is required to verify whether the association between traditional NSAIDs and TB is causal, or simply reflects an increased use of anti-inflammatory drugs in the early phases of TB onset.

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