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

Autor: Alexander G. Mathioudakis, Tor Biering-Sørensen, Thyge L. Nielsen, Julie Janner, Charlotte Suppli Ulrik, Vibeke Gottlieb, Jørgen Vestbo, Jonas Rutishauser, Thérèse S. Lapperre, Karin Armbruster, Beat Mueller, Andrea Browatzki, Mia Moberg, Pradeesh Sivapalan, Jens-Ulrik Stæhr Jensen, Jörg D. Leuppi, Josefin Eklöf, Philipp Schuetz, Lars Egholm Pedersen
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Time Factors
Exacerbation
ORAL CORTICOSTEROIDS
THERAPY
law.invention
Pulmonary Disease
Chronic Obstructive
0302 clinical medicine
law
Adrenal Cortex Hormones
Risk Factors
Multicenter Studies as Topic
030212 general & internal medicine
Prospective cohort study
Lung
Randomized Controlled Trials as Topic
COPD
Days alive and out of hospital
Hazard ratio
Middle Aged
Intensive care unit
Hospitalization
Treatment Outcome
Disease Progression
SHORT-TERM
Female
SYSTEMIC GLUCOCORTICOIDS
medicine.medical_specialty
DURATION
Risk Assessment
OBSTRUCTIVE PULMONARY-DISEASE
Drug Administration Schedule
Diseases of the respiratory system
03 medical and health sciences
Internal medicine
medicine
Humans
Corticosteroids
Mortality
Aged
RC705-779
business.industry
Research
MORTALITY
Odds ratio
medicine.disease
Confidence interval
Regimen
030228 respiratory system
Human medicine
business
Zdroj: Respiratory research
Sivapalan, P, Rutishauser, J, Ulrik, C S, Leuppi, J D, Pedersen, L, Mueller, B, Eklof, J, Biering-Sorensen, T, Gottlieb, V, Armbruster, K, Janner, J, Moberg, M, Lapperre, T S, Nielsen, T L, Browatzki, A, Mathioudakis, A, Vestbo, J, Schuetz, P & Jensen, J-U 2021, ' 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, vol. 22, no. 1, 155 . https://doi.org/10.1186/s12931-021-01745-5
Respiratory Research
Respiratory Research, Vol 22, Iss 1, Pp 1-9 (2021)
Sivapalan, P, Rutishauser, J, Ulrik, C S, Leuppi, J D, Pedersen, L, Mueller, B, Eklöf, J, Biering-sørensen, T, Gottlieb, V, Armbruster, K, Janner, J, Moberg, M, Lapperre, T S, Nielsen, T L, Browatzki, A, Mathioudakis, A, Vestbo, J, Schüetz, P & Jensen, J 2021, ' 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, vol. 22, no. 1 . https://doi.org/10.1186/s12931-021-01745-5
ISSN: 1465-9921
DOI: 10.1186/s12931-021-01745-5
Popis: Background Systemic 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. Methods We 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. Results The 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 p p 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. Conclusion 14-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.
Databáze: OpenAIRE
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