COPD Exacerbations Reduced With Short Corticosteroid Course

There is welcome news for patients with chronic obstructive pulmonary disease (COPD) who experience multiple exacerbations annually and are exposed to repeated courses of systemic corticosteroids. Patients who experience an exacerbation of their symptoms respond to 5 days of corticosteroid therapy just as well as to 14 days of therapy, according to a randomized, double-blind, controlled trial.

“This means that COPD patients can be spared long treatments with steroids. This will likely reduce their chances of developing undesired drug effects,” Jorg D. Leuppi, MD, PhD, of the University Hospital of Basel, Switzerland, told ConsultantLive.

Dr Leuppi and colleagues conducted a study to examine whether a short-term (5 days) systemic corticosteroid treatment in patients with COPD exacerbation is noninferior to conventional (14 days) treatment and whether it decreases exposure to corticosteroids. The trial, conducted in 5 Swiss teaching hospitals, enrolled 314 patients presenting to the emergency department with acute COPD exacerbation; they were past or present smokers without a history of asthma.

Patients received treatment with 40 mg of prednisone daily for 5 or 14 days in a placebo-controlled fashion. The predefined noninferiority criterion was an absolute increase in exacerbations of at most 15%. The primary measured outcome was time to next exacerbation within 180 days.

Some 56 patients reached the primary end point of COPD exacerbation in the short-term treatment group compared with 57 patients in the conventional treatment group. Time to re-exacerbation did not differ between groups.

Among patients who experienced a re-exacerbation during follow-up, the median time to event was 43.5 days in the short-term group and 29 days in the conventional treatment group. Estimates of re-exacerbation rates were 37.2% in the short-term and 38.4% in the conventional treatment group.

“There was no difference between groups in time to death, the combined end point of exacerbation, death or both, and recovery of lung function. In the conventional group, mean cumulative prednisone dose was significantly higher (793 mg vs. 379 mg), but treatment-associated adverse reactions, including hyperglycemia and hypertension, did not occur more frequently,” the authors wrote.
 
During the hospital stay, there was no increase in the requirement for mechanical ventilation with the short-term treatment regimen.

“There was no significant difference in recovery of lung function and disease-related symptoms, but the shorter course resulted in a significantly reduced glucocorticoid exposure,” the authors wrote. “These findings support the use of a 5-day glucocorticoid treatment in acute exacerbations of COPD.”

Dr Leuppi’s message to primary care physicians: “Patients with acute exacerbation of COPD can be treated with 5 days of steroids rather than 10 or 14 days, which has been recommended up until now. Patients who experience multiple exacerbations and require repeated courses of systemic steroids will be exposed to a lower cumulative steroid dose over time.”

Whether this reduces the short-term and long-term adverse effects of corticosteroids will be studied in more detail in a planned substudy, Dr Leuppi said.

The researchers reported their results online on May 21 in the Journal of the American Medical Association.