Pierre Ernst

Pierre Ernst
McGill University | McGill · Department of Medicine

MD, MSc

About

354
Publications
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Publications

Publications (354)
Article
Triple therapy for chronic obstructive pulmonary disease (COPD) is recommended for some patients, but the inhaled corticosteroids (ICS) may differ in effectiveness and safety. We compared budesonide-based and fluticasone-based triple therapy given in two inhalers on the incidence of exacerbation, mortality and severe pneumonia, using an observation...
Article
Recent reports provide evidence-based guidelines for the withdrawal of inhaled corticosteroids (ICS) in COPD, but data on patients treated with ICS-based triple therapy are sparse and contradictory. We assessed the effect of ICS discontinuation on the incidence of severe exacerbation and pneumonia in a real-world population of patients with COPD wh...
Article
Background Guidelines for the treatment of chronic obstructive pulmonary disease (COPD) patients with multiple exacerbations and eosinophilia recommend a long-acting beta2-agonist (LABA) and inhaled corticosteroid (ICS) combined inhaler, with no distinction between different agents. We compared the effectiveness and safety of budesonide-formoterol...
Article
Randomized trials of triple therapy including an inhaled corticosteroid (ICS) for chronic obstructive pulmonary disease (COPD) reported remarkable benefits on mortality compared with dual bronchodilators, likely resulting from ICS withdrawal at randomization. We compared triple therapy with dual bronchodilator combinations on major COPD outcomes in...
Article
Purpose: To evaluate the impact of concomitant use of conventional synthetic DMARDs (csCMARD) on adherence, switching and dose of biologic disease modifying antirheumatic drugs (bDMARD) in rheumatoid arthritis (RA) patients treated with bDMARDs. Patients and methods: This was a population-based cohort study conducted in five provinces of Canada...
Article
Full-text available
Background Serious adverse effects of fluoroquinolone antibiotics have been described for more than decade. Recently, several drug regulatory agencies have advised restricting their use in milder infections for which other treatments are available, given the potential for disabling and possibly persistent side effects. We aimed to describe variatio...
Article
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Background Cardiovascular death is a common outcome in population-based studies about new healthcare interventions or treatments, such as new prescription medications. Vital statistics registration systems are often the preferred source of information about cause-specific mortality because they capture verified information about the deceased, but t...
Article
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations for the initial bronchodilator to use in newly diagnosed chronic obstructive pulmonary disease (COPD) are based on trials of patients with longstanding disease and treatment. We compared the real world effectiveness of initial treatment with long-acting muscarinic age...
Article
Full-text available
Background: People with type 2 diabetes are at greater risk for infections than those without type 2 diabetes. Our objective was to examine the association between type 2 diabetes and the risk of community-acquired pneumonia (CAP). Methods: In this systematic review and meta-analysis, we searched MEDLINE, Embase, CINAHL, ProQuest theses and diss...
Article
Purpose: Sodium-glucose co-transporter 2 inhibitors (SGLT-2i) have been associated with an increased risk of genitourinary tract infections. Through similar biological mechanisms, they may also increase the risk of community-acquired pneumonia. Our objective was to compare the rate of hospitalization for community-acquired pneumonia (HCAP) with SGL...
Article
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Objective: To compare the risk of cardiovascular events between sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors among people with type 2 diabetes in a real world context of clinical practice. Design: Multi-database retrospective cohort study using a prevalent new user design with subsequent meta-an...
Article
OBJECTIVE Reports of amputations associated with sodium–glucose cotransporter 2 (SGLT2) inhibitors have been inconsistent. We aimed to compare the risk of below-knee amputation with SGLT2 inhibitors versus dipeptidyl peptidase 4 (DPP-4) inhibitors among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS This multicenter observational study...
Article
Background: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors could increase the risk for diabetic ketoacidosis (DKA). Objective: To assess whether SGLT-2 inhibitors, compared with dipeptidyl peptidase-4 (DPP-4) inhibitors, are associated with an increased risk for DKA in patients with type 2 diabetes. Design: Population-based cohort study; p...
Article
Aims: The United States Food and Drug Administration has warned of an increased risk of serious urinary tract infection (UTI) and Fournier's gangrene in patients with diabetes mellitus type 2 treated with sodium-glucose cotransporter 2 inhibitors (SGLT2i). However, evidence on these risks is limited. We aimed to compare urosepsis rates in SGLT2i u...
Article
A recent study found a decreased risk of Parkinson's disease (PD) associated with the β2 agonist salbutamol. However, other mechanisms may explain this apparent association. Using the United Kingdom Clinical Practice Research Datalink, we formed a cohort of 2,430,884 patients aged 50 or over between 1995 and 2016. During follow-up, 8,604 cases of P...
Article
Full-text available
Purpose: Fluoroquinolone antibiotics are associated with rare, but severe adverse events. They are frequently used for the treatment of acute exacerbations of COPD (AECOPD). While their effectiveness in severe exacerbations requiring hospitalisation has been well documented, the potential benefit in the ambulatory setting is less clear, especially...
Article
Background Inhaled corticosteroids (ICS) are suggested as potential chemoprevention of lung cancer. Several observational studies in patients with COPD reported inconsistent results, either significant reductions in lung cancer incidence with ICS use or no effect. We assessed this association, using an approach that avoided biases affecting some of...
Article
Background: Triple therapy combinations of a long-acting muscarinic antagonist, a long-acting beta2-agonist and an inhaled corticosteroid (LAMA-LABA-ICS) for chronic obstructive pulmonary disease (COPD) were studied in randomized trials and observational studies, with variable results. We compared the effectiveness and safety of triple therapy to...
Article
Full-text available
Objectives: The United States Food & Drug Administration released an advisory in 2016 that fluoroquinolones be relegated to second line agents for uncomplicated urinary tract infections (UTIs) given reports of rare but serious side effects; similar warnings have followed from Health Canada and the European Medicines Agency. The objective was to de...
Article
Objectives: Abatacept, a biologic DMARD, was associated with respiratory adverse events in a small subgroup of RA patients with chronic obstructive pulmonary disease (COPD) in a trial. Whether this potential risk is specific to abatacept or extends to all biologics and targeted synthetic DMARDs (tsDMARDs) is unclear. We assessed the risk of advers...
Conference Paper
Background The biologic DMARD abatacept has been associated with respiratory adverse events in patients with RA who have chronic obstructive pulmonary disease (COPD) in the ASSURE trial (NCT00048932), based on only 54 patients with RA and COPD.¹ A large observational study of patients with RA and COPD, involving over 1,800 patients using abatacept...
Article
Objective: The ASSURE randomized trial of abatacept safety in rheumatoid arthritis (RA) reported more frequent respiratory adverse events with abatacept among the subgroup of 54 patients with chronic obstructive pulmonary disease (COPD), leading to a label warning. We assessed the risk of adverse respiratory events associated with abatacept, compa...
Article
Background: Long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are recommended as initial maintenance treatments for COPD, with their combination (LABA-LAMA) advocated as the disease progresses. Randomized trials comparing the effectiveness of this combination with the alternative combination of LABA with inhaled cortic...
Article
Background Long-acting β2 agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are the recommended initial maintenance treatment for chronic obstructive pulmonary disease (COPD), with almost all LABAs dispensed in fixed combination with inhaled corticosteroids (LABA-ICS). We compared the effectiveness and safety of LABA-ICS versus LAMA t...
Conference Paper
Background In the ASSURE trial (NCT00048932) comparing abatacept with placebo for the treatment of RA, there was an increased incidence of respiratory serious adverse events (SAEs; COPD exacerbation/worsening, bronchitis and pneumonia) in those receiving abatacept among the subgroup of 54 patients with a history of chronic obstructive pulmonary dis...
Article
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Asthma: ENCOURAGING DOCTORS TO PROVIDE WRITTEN ACTION PLANS: Changes to practice organization and doctors' perceptions should encourage the provision of written action plans for all asthma patients. International guidelines state that effective long-term treatment of asthma requires educated self-management, regular reviews and provision of a writ...
Article
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Objective To determine the safety of direct oral anticoagulant (DOAC) use compared with warfarin use for the treatment of venous thromboembolism. Design Retrospective matched cohort study conducted between 1 January 2009 and 31 March 2016. Setting Community based, using healthcare data from six jurisdictions in Canada and the United States. Part...
Article
Introduction: It is uncertain whether long-term use of inhaled corticosteroids (ICS), widely used to treat COPD, increases the risk of fracture, particularly in women, in view of the post-menopausal risks. We assessed whether long-term ICS use in patients with COPD increases the risk of hip or upper extremity fractures, and examined sex-related di...
Article
The cardiovascular risk of concurrently using long-acting β 2 -agonists (LABAs) and anticholinergics (LAMAs) in COPD is uncertain. We assessed the comparative cardiovascular and cerebrovascular safety of adding a second long-acting bronchodilator in patients with COPD. We identified a cohort of COPD patients, new users of LABA or the LAMA tiotropiu...
Article
Aim: Studies have linked the use of inhaled corticosteroids (ICS) to excess pneumonia risk in COPD patients. The risk in asthma patients remains unclear. The objective was to examine the risk of pneumonia with ICS in patients 12 to 35 years old with asthma. Methods: We formed a cohort of asthma patients treated from 1990-2007 using Quebec health...
Article
The use of oral and inhaled corticosteroids is associated with increases in the risk of infection, especially pneumonia. The risk of sepsis with corticosteroid treatment in patients with chronic obstructive pulmonary disease (COPD) has been little studied, however. We assessed whether the use of inhaled and oral corticosteroids in COPD is associate...
Article
Background: Androgens have been shown to influence both the immune system and lung tissue, raising the hypothesis that androgen deprivation therapy (ADT) for prostate cancer may increase the risk of pneumonia. Thus, the aim of this study was to determine whether ADT is associated with an increased risk of hospitalisation for community-acquired pneu...
Article
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Background Whether Web-based technologies can improve disease self-management is uncertain. My Asthma Portal (MAP) is a Web-based self-management support system that couples evidence-based behavioral change components (self-monitoring of symptoms, physical activity, and medication adherence) with real-time monitoring, feedback, and support from a n...
Article
Aim: Previous studies suggest that statins may have beneficial respiratory effects. However, it is unclear if these purported benefits vary with statin potency. Our objective was to determine if higher potency statins, compared with lower potency statins, were associated with a reduced risk of hospitalization for community-acquired pneumonia (HCAP...
Article
Background: Asthma control remains suboptimal in Canada. Expansion of pharmacist's professional activities offers the opportunity to improve the interdisciplinary management of patients with asthma. Objective: The aim of this study was to determine the level of agreement of physicians regarding the expansion of pharmacists' professional activiti...
Article
Purpose: The effect of statins on cytokine-mediated inflammatory responses may impact on the prognosis of influenza. We assessed whether statin use decreases the incidence of adverse influenza-related outcomes. Additionally, we used a new-user study design to minimize healthy user bias. We further examined the possibility of non-causal association...
Article
Long-acting beta2-agonists (LABA) and the anticholinergic tiotropium are used extensively to treat COPD, but the cardiovascular safety of their concurrent use is uncertain. We conducted a population-based cohort study to evaluate whether adding a second long-acting bronchodilator increases the risk of acute myocardial infarction (AMI), stroke, hear...
Article
Inhaled corticosteroids (ICS) are widely used to treat chronic obstructive pulmonary disease (COPD), often early in the course of disease and at higher doses. The safety concerns for osteoporosis and fractures with long-term use of ICS could particularly affect post-menopausal women with decreased bone density. To date, the studies have been inconc...
Article
Long-acting bronchodilators, including long-acting beta2-agonists (LABA) and the anticholinergic tiotropium, are recommended as initial maintenance treatment in COPD, though their risk on cardio-pulmonary events remains uncertain in real world settings. We assessed whether treatment initiation with tiotropium increases the risk of acute myocardial...
Article
Background: Long-acting bronchodilators, including long-acting beta2-agonists (LABA) and the anticholinergic tiotropium, are recommended as initial maintenance therapy in COPD. Studies to date have been limited in size and reported ambivalent results on the comparative risk of cardiovascular, cerebrovascular and pulmonary adverse events between th...
Article
Full-text available
Importance: The association between incretin-based drugs, such as dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists, and acute pancreatitis is controversial. Objective: To determine whether the use of incretin-based drugs, compared with the use of 2 or more other oral antidiabetic drugs, is associated with an...
Article
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Aim: Domperidone is preferentially used over other antiemetic agents to treat digestive symptoms in Parkinson's disease (PD). Concerns have been raised regarding an increased risk of ventricular tachyarrhythmia and sudden cardiac death (VT/SCD) associated with domperidone in the general population. However, the risk in PD is unknown. Methods: We...
Article
Background There is concern that antidiabetic incretin-based drugs, including dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) analogues, can increase the risk of heart failure. Ongoing clinical trials may not have large enough samples to effectively address this issue. Methods We applied a common protocol in the analy...
Article
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Objective To determine whether the use of incretin based drugs compared with sulfonylureas is associated with an increased risk of incident pancreatic cancer in people with type 2 diabetes. Design Population based cohort. Setting Large, international, multicentre study combining the health records from six participating sites in Canada, the United...
Article
Patients with chronic obstructive pulmonary disease (COPD) have higher incidence and prevalence of other chronic inflammatory diseases, including inflammatory bowel disease (IBD). We assessed whether IBD onset increases mortality risk in patients with COPD or asthma-associated COPD. Two population-based cohorts of COPD and asthma-COPD subjects wer...
Article
Extract In a recent paper on the INPULSIS trials, two duplicate 1-year randomised controlled trials evaluating nintedanib in the treatment of idiopathic pulmonary fibrosis (IPF) [1], we provided the methodological explanation for the apparent inconsistent results arising from the two different definitions of exacerbations used in those studies [2]....
Article
Full-text available
Objective . We aimed to identify key enablers of physician prescription of a long-term controller in patients with persistent asthma. Methods . We conducted a mailed survey of randomly selected Quebec physicians. We sent a 102-item questionnaire, seeking reported management regarding one of 4 clinical vignettes of a poorly controlled adult or child...
Data
The supplemental materiel describes the clinical vignettes (Table E1), the comparison between participants and non-participants (Table E2), the reported assessment of, and prescription for, each case vignette (Table E3), the beliefs about capabilities and consequences regarding the prescription of long-term asthma controller (Table E4), the multiva...
Article
Purpose: The potential consequences of confounding due to drug formulary restrictions in pharmacoepidemiologic research remain incompletely understood. Our objective was to illustrate this potential bias using the example of fluticasone/salmeterol combination therapy, an oral inhaler used to treat asthma and chronic obstructive pulmonary disease,...
Article
SESSION TITLE: COPD Poster Discussion SESSION TYPE: Original Investigation Poster Discussion PRESENTED ON: Sunday, October 25, 2015 at 01:30 PM - 03:00 PM PURPOSE: Chronic obstructive lung disease (COPD) is a highly prevalent disease that often goes undiagnosed. Patients with COPD are at higher risk for post-operative complications such as exacerba...
Article
SESSION TITLE: Allergy and Airway Poster Discussions SESSION TYPE: Original Investigation Poster Discussion PRESENTED ON: Wednesday, October 28, 2015 at 08:45 AM - 10:00 AM PURPOSE: The assessment of airway inflammation by sputum induction is an essential tool in the evaluation of severe asthmatic patients. Treatment guidance using eosinophil and n...
Article
A safety signal regarding cases of AKI after exposure to serotonin-norepinephrine reuptake inhibitors (SNRIs) was identified by Health Canada. Therefore, this study assessed whether the use of SNRIs increases the risk of AKI compared with selective serotonin reuptake inhibitors (SSRIs) and examined the risk associated with each individual SNRI. Mul...
Article
Determining the factors that will predict long-term asthma control is essential for improving health outcomes and decreasing the burden on the health care system. Patient-reported outcomes (PROs) on health behaviors can provide valuable information about future asthma control but have rarely been considered in previous analyses. To develop statisti...
Article
The widespread use of inhaled corticosteroids for COPD treatment has been questioned. Recent studies of weaning some COPD patients off inhaled corticosteroids found little or no loss in adverse consequences compared with long-acting bronchodilators. It is however unclear whether their discontinuation reduces the elevated risk of pneumonia associate...
Conference Paper
BACKGROUND Despite clear guidelines, many school-aged children with persistent asthma are not prescribed long-term asthma controller by their physician. OBJECTIVES To identify of key facilitators and solutions proposed by physicians to facilitate long-term prescription of asthma controller in children with persistent asthma (for ≥3 months or until...
Article
Full-text available
Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identi...
Article
Significant differences in outcome are observed among lung cancer patients belonging to the same tumor node metastasis stage, suggesting phenotypic heterogeneity beyond this staging algorithm. We used a cluster analysis approach to classify patients into distinct phenotypes, and we attempted to validate the clinical relevance of these phenotypes by...
Article
Introduction Les inhibiteurs de la dipeptidyl peptidase-4 (DPP-4) pourraient modifier la réponse immunitaire et augmenter le risque infectieux, mais les preuves de cette association sont limitées. L’objectif de cette étude était de déterminer si l’utilisation des inhibiteurs de la DPP-4 est associée à un risque accru de pneumonie d’origine communau...
Article
Full-text available
Although asthma morbidity can be prevented through long-term controller medication, most patients with persistent asthma do not take their daily inhaled corticosteroid. The objective of this study was to gather patients' insights into barriers and facilitators to taking long-term daily inhaled corticosteroids as basis for future knowledge translati...
Article
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Computer-based decision support has been effective in providing alerts for preventive care. Our objective was to determine whether a personalized asthma management computer-based decision support increases the quality of asthma management and reduces the rate of out-of-control episodes. A cluster-randomized trial was conducted in Quebec, Canada amo...
Article
To the Editor In their observational study assessing the long-term outcomes associated with use of long-acting β-agonists (LABAs) in combination with inhaled corticosteroids (ICSs) in chronic obstructive pulmonary disease (COPD), Dr Gershon and colleagues¹ reported that ICS use was not associated with pneumonia risk. This finding contradicts large...
Article
AimDipeptidyl peptidase-4 (DPP-4) inhibitors may alter the immune response and increase the risk of infections, but evidence for this association is limited. Thus, the objective of this study was to determine whether the use of DPP-4 inhibitors is associated with an increased risk of community-acquired pneumonia.Materials and methodsThe United King...
Article
In this article, we focus on the scientific evidence from randomised trials supporting treatment with inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), including treatment with combinations of long-acting β-agonist (LABA) bronchodilators and ICS. Our emphasis is on the methodological strengths and limitations that guide...
Article
The recently published INPULSIS studies, two duplicate randomised trials evaluating nintedanib in the treatment of idiopathic pulmonary fibrosis (IPF) over 1 year, reported effectiveness in terms of declining lung function, but inconsistent results on exacerbations of IPF.1 ,2 Indeed, in the prespecified pooled analysis of the two trials, the risk...
Article
The objective of the study was to assess whether the incidences of Crohn’s disease and ulcerative colitis are increased in patients with asthma and chronic obstructive pulmonary disease (COPD) compared to the general population. A population-based retrospective cohort study was conducted using the administrative health databases of Québec, Canada....
Article
While weekend hospital admissions are associated with higher mortality, the effects of weekend hospital stays are not known. We assessed whether patients hospitalised for chronic obstructive pulmonary disease (COPD) or pneumonia have higher mortality during weekend and Friday stays. Our cohort consisted of all hospitalisations for COPD or pneumonia...
Article
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To estimate the extent to which symptom status, physical activity, beliefs about medications, self-efficacy, emotional status, and healthcare utilization predict perceived asthma control over a period of 16 months among a primary care population. The current study is a secondary analysis of data from a longitudinal study that examined health outcom...
Article
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Objective Previous observational studies suggest that the use of proton pump inhibitors (PPIs) may increase the risk of hospitalisation for community-acquired pneumonia (HCAP). However, the potential presence of confounding and protopathic biases limits the conclusions that can be drawn from these studies. Our objective was, therefore, to examine t...
Article
Full-text available
Inhaled corticosteroids (ICS) are known to increase the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). It is unclear whether the risk of pneumonia varies for different inhaled agents, particularly fluticasone and budesonide, and increases with the dose and long-term duration of use. We formed a new-user cohort of p...
Article
Full-text available
Dedicated programs for the management of chronic obstructive pulmonary disease (COPD) can reduce hospitalizations and improve quality of life. To investigate whether health care utilization could be reduced by a newly developed integrated, interdisciplinary initiative that included a COPD nurse navigator who educates patients and families, transiti...
Article
Purpose: Infl ammatory bowel disease (IBD) and airway diseases may be associated through common infl ammatory pathways, genetic, and environmental factors. Th e prevalence of both Crohn’s disease (CD) and ulcerative colitis (UC) seems to be increased among patients with airway diseases. Québec is the province with the second highest incidence and p...