Impact of inhaled corticosteroids on metabolic dysfunction-associated steatotic liver disease risk in COPD patients

Background: The systemic impact of long-term use of inhaled corticosteroid (ICS) on the liver remains poorly understood in patients with chronic obstructive pulmonary disease (COPD). Our study aimed to identify whether long-term ICS therapy impacts the risk of Metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with COPD. Methods: A retrospective cohort study was conducted using claims records from a large population-based database. We included COPD patients ≥40 years old who had no previous history of chronic liver disease. Patients were divided into two groups based on their ICS use. The primary outcome was the development of MASLD. Additionally, subgroup analyses were conducted according to the duration of ICS exposure and the various components of ICS. Results: A total of 442,880 COPD patients were included in the study, with 95,695 in ICS group and 347,185 in non-ICS group. The incidence rate of MASLD was higher in the ICS group compared to the non-ICS group (859.3 vs. 440.4 per 100,000 person-years). After adjusting for potential confounding factors, ICS use was associated with a significantly increased risk of MASLD (hazard ratio [HR]=1.630, 95 % confidence interval [CI]=1.560–1.704). Fluticasone furoate showed a higher risk of MASLD compared to other ICS components, and a longer duration of ICS exposure was associated with an increased MASLD risk. Conclusions: In COPD patients, long-term use of ICS may be associated with an increased risk of developing MASLD. Further studies are needed to explore strategies to mitigate the potential risk of MASLD in COPD patients requiring ICS therapy.