Corticosteroids for COPD Exacerbations: When Less Is More

By Health & Medical Half year ago

Short-term vs Conventional Glucocorticoid Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: The REDUCE Randomized Clinical Trial

Leuppi JD, Schuetz P, Bingisser R, et al
JAMA. 2013 May 21. [Epub ahead of print]

Study Summary

Acute exacerbations of COPD are serious events that require aggressive treatment to avoid complications, including death. The recommended prescription is 40 mg of prednisone per day for 14 days. But given that oral corticosteroids themselves can have long-term adverse effects, would a shorter treatment period be as effective?

A multicenter trial was performed in Switzerland to determine whether a 5-day course of 40 mg of prednisone daily was noninferior to the conventional 14-day course at the same dose level. The trial enrolled 603 patients presenting with an acute exacerbation of COPD and randomly assigned them to receive all usual therapies plus a 40-mg daily dose of oral prednisone for either 5 or 14 days.

The primary endpoint was time to the next exacerbation in a 6-month follow-up. Secondary endpoints included duration of hospitalization; mortality; change in FEV₁; and questionnaires on symptom severity, clinical status, and quality of life.

Almost one third of the patients in each group experienced an exacerbation -- 35.9% in the conventional treatment arm and 36.8% in the shorter treatment arm, which was considered to be a noninferior difference. The time to the first exacerbation, need for mechanical ventilation, improvement in lung function, duration of hospitalization, and mortality were likewise almost identical in the 2 treatment arms.

The only meaningful difference between the treatment arms was the amount of prednisone consumed during the treatment and follow-up months, which was twice as large in the 14-day treatment arm. Adverse events, hyperglycemia and hypertension, were infrequent, and again, the frequency was about the same in both treatment arms. The investigators concluded that these findings support the use of a 5-day corticosteroid treatment regimen for acute exacerbations of COPD.

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