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Short-term course of glucocorticoids for COPD

18 Jun, 13 | by kuppell

A short-term 5-day, rather than 14-day, course of glucocorticoid treatment should be used for acute exacerbations of chronic obstructive pulmonary disease (COPD) according to a study published in JAMA. The Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) study was a randomised, non-inferiority Swiss trial which enrolled 314 patients (from March 2006 to February 2011) presenting to the emergency departments of five hospitals with acute COPD exacerbations. Patients were past or present smokers (≥20 pack-years) without a history of asthma.

Patients received 40mg of prednisone daily for either 5 or 14 days in a placebo-controlled double-blind manner. The main outcome was time to next COPD exacerbation during a follow-up of 6 months.

Of the 314 patients, 311 were included in the intention-to-treat analysis and 296 in the per-protocol analysis. Hazard ratios (HRs) for the short-term versus 14-day treatment group were 0.95 (90% CI, 0.70 to 1.29; p=0.006 for non-inferiority) in the intention-to-treat analysis and 0.93 (90% CI, 0.68 to 1.26; p=0.005 for non-inferiority) in the per-protocol analysis, meeting the researchers non-inferiority criterion. In the 5-day treatment group, 56 patients (35.9%) reached the primary end point and 57 (36.8%) in the 14-day group. Estimates of reexacerbation rates within 6 months were 37.2% (95% CI, 29.5% to 44.9%) in the short-term group with median time to event being 43.5 days and were 38.4% (95% CI, 30.6% to 46.3%) in the 14-day treatment group with median time to event of 29 days.

The authors conclude that: ‘In patients presenting to the emergency department with acute exacerbations of COPD, 5-day treatment with systemic glucocorticoids was noninferior to 14-day treatment with regard to reexacerbation within 6 months of follow-up but significantly reduced glucocorticoid exposure. These findings support the use of a 5-day glucocorticoid treatment in acute exacerbations of COPD.’ JAMA 2013;309:2223-31.

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