Effect of different corticosteroid regimes for hospitalised patients with exacerbated COPD: pooled analysis of individual participant data from the REDUCE and CORTICO-COP trials

Respiratory Research

Tor Biering-Sørensen¹  Jonas Rutishauser²  Therese S. Lapperre³  Lars Pedersen⁴  Charlotte Suppli Ulrik⁵  Julie Janner⁵  Mia Moberg⁵  Thyge L. Nielsen⁶  Andrea Browatzki⁶  Philipp Schüetz⁷  Jörg D. Leuppi⁸  Karin Armbruster⁹  Vibeke Gottlieb⁹  Josefin Eklöf⁹  Jens-Ulrik Jensen⁹  Pradeesh Sivapalan^1,10  Alexander Mathioudakis^1,11  Jørgen Vestbo^1,11  Beat Mueller^1,12 

[1] Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark;Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Department of Medicine, Clinical Trial Unit, Kantonsspital Baden, 4054, Baden, Switzerland;Faculty of Medicine, University of Basel, 4001, Basel, Switzerland;Department of Respiratory Medicine, Antwerp University Hospital, and Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium;Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark;Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark;Department of Respiratory and Infectious Diseases, Frederiksund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark;Faculty of Medicine, University of Basel, 4001, Basel, Switzerland;Medical University Department, Kantonsspital Aarau, 5001, Aarau, Switzerland;Faculty of Medicine, University of Basel, 4001, Basel, Switzerland;University Clinic of Medicine, Kantonsspital Baselland, 4410, Liestal, Switzerland;Section of Respiratory Medicine, Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark;Section of Respiratory Medicine, Department of Internal Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark;Department of Internal Medicine, Zealand University Hospital, University of Copenhagen, 4000, Roskilde, Denmark;The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK;Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK;University Clinic of Medicine, Kantonsspital Baselland, 4410, Liestal, Switzerland;Medical University Department, Kantonsspital Aarau, 5001, Aarau, Switzerland;

关键词: COPD;    Exacerbation;    Corticosteroids;    Mortality;    Days alive and out of hospital;    Intensive care unit;   

DOI  :  10.1186/s12931-021-01745-5

来源: Springer

【 摘 要 】

BackgroundSystemic corticosteroid administration for severe acute exacerbations of COPD (AECOPD) reduces the duration of hospital stays. Corticosteroid-sparing regimens have showed non-inferiority to higher accumulated dose regimens regarding re-exacerbation risk in patients with AECOPD. However, it remains unclear whether 14-day or 2–5-day regimens would result in shorter admission durations and changes in mortality risk. We explored this by analysing the number of days alive and out of hospital based on two randomised controlled trials with different corticosteroid regimens.MethodsWe pooled individual patient data from the two available multicentre randomised trials on corticosteroid-sparing regimens for AECOPD: the REDUCE (n = 314) and CORTICO-COP (n = 318) trials. In the 14-day regimen group, patients were older, fewer patients received pre-treatment with antibiotics and more patients received pre-treatment with systemic corticosteroids. Patients randomly allocated to the 14-day and 2–5-day regimens were compared, with adjustment for baseline differences.ResultsThe number of days alive and out of hospital within 14 days from recruitment was higher for the 2–5 day regimen group (mean 8.4 days; 95% confidence interval [CI] 8.0–8.8) than the 14-day regimen patient group (4.2 days; 95% CI3.4–4.9; p < 0.001). The 14-day AECOPD group had longer hospital stays (mean difference, 5.4 days [standard error ± 0.6]; p < 0.0001) and decreased likelihood of discharge within 30 days (hazard ratio [HR] 0.5; 95% CI 0.4–0.6; p < 0.0001). Comparing the 14-day regimen and the 2–5 day regimen group showed no differences in the composite endpoint ‘death or ICU admission’ (odds ratio [OR] 1.4; 95% CI 0.8–2.3; p = 0.15), new or aggravated hypertension (OR 1.5; 95% CI 0.9–2.7; p = 0.15), or mortality risk (HR 0.8; 95% CI 0.4–1.5; p = 0.45) during the 6-month follow-up period.Conclusion14-day corticosteroid regimens were associated with longer hospital stays and fewer days alive and out of hospital within 14 days, with no apparent 6-month benefit regarding death or admission to ICU in COPD patients. Our results favour 2–5 day regimens for treating COPD exacerbations. However, prospective studies are needed to validate these findings.

【 授权许可】

CC BY