Richard Beasley, Medical Research Institute of New Zealand, PO Box 10055, Wellington 6143, New Zealand. Email: [email protected]Search for more papers by this author

Mark WEATHERALL,

Mark WEATHERALL

University of Otago, and

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Jennifer CLAY,

Jennifer CLAY

Medical Research Institute of New Zealand, Wellington, New Zealand, and

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Kate JAMES,

Kate JAMES

Medical Research Institute of New Zealand, Wellington, New Zealand, and

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Kyle PERRIN,

Kyle PERRIN

Medical Research Institute of New Zealand, Wellington, New Zealand, and

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Philippa SHIRTCLIFFE,

Philippa SHIRTCLIFFE

Medical Research Institute of New Zealand, Wellington, New Zealand, and

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Richard BEASLEY,

Corresponding Author

Richard BEASLEY

Medical Research Institute of New Zealand, Wellington, New Zealand, and

University of Southampton, Southampton, UK

Richard Beasley, Medical Research Institute of New Zealand, PO Box 10055, Wellington 6143, New Zealand. Email: [email protected]Search for more papers by this author

First published: 02 September 2009

https://doi.org/10.1111/j.1440-1843.2009.01589.x

Citations: 73

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.

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ABSTRACT

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.

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Dose–response relationship of inhaled corticosteroids and cataracts: A systematic review and meta-analysis

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