Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study
| Autor: | Helgo Magnussen, Sarah Lucas, Therese Lapperre, Jennifer K. Quint, Ronald J. Dandurand, Nicolas Roche, Alberto Papi, David Price, Marc Miravitlles, the Respiratory Effectiveness Group (REG) |
|---|---|
| Přispěvatelé: | Institut Català de la Salut, [Magnussen H] Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North, Member of the German Center of Lung Research, Grosshansdorf, Germany. [Lucas S] Respiratory Efectiveness Group, Ely, UK. [Lapperre T] Department of Respiratory Medicine, Antwerp University Hospital, Edegem, Denmark. Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Wilrijk, UK. [Quint JK] Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Wilrijk, UK. [Dandurand RJ] CIUSSS de L’Ouest de L’Île de Montréal, Montreal Chest Institute, Meakins Christie Laboratories, Oscillometry Unit and Centre for Innovative Medicine, McGill University Health Centre and Research Institute, Montreal, QC, Canada. [Miravitlles M] Servei de Pneumologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Respiratory Effectiveness Group (REG) |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
Exacerbation Respiratory System Effectiveness Pulmons - Malalties obstructives - Tractament Rate ratio Other subheadings::Other subheadings::/drug therapy [Other subheadings] Pulmonary Disease Chronic Obstructive 0302 clinical medicine Adrenal Cortex Hormones 030212 general & internal medicine 1102 Cardiorespiratory Medicine and Haematology Aged 80 and over COPD education.field_of_study Inhaled corticosteroids Pharmacoepidemiology Middle Aged Bronchodilator Agents enfermedades respiratorias::enfermedades pulmonares::enfermedades pulmonares obstructivas::enfermedad pulmonar obstructiva crónica [ENFERMEDADES] Treatment Outcome Withdrawal Female COPD effectiveness inhaled corticosteroids real life withdrawal medicine.medical_specialty Population Real life Socio-culturale Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores] Respiratory Effectiveness Group (REG) 03 medical and health sciences Safety-Based Drug Withdrawals Internal medicine Pharmacovigilance Administration Inhalation medicine Humans education Aged lcsh:RC705-779 Respiratory Tract Diseases::Lung Diseases::Lung Diseases Obstructive::Pulmonary Disease Chronic Obstructive [DISEASES] business.industry Research diagnóstico::pronóstico::resultado del tratamiento [TÉCNICAS Y EQUIPOS ANALÍTICOS DIAGNÓSTICOS Y TERAPÉUTICOS] 1103 Clinical Sciences lcsh:Diseases of the respiratory system medicine.disease Diagnosis::Prognosis::Treatment Outcome [ANALYTICAL DIAGNOSTIC AND THERAPEUTIC TECHNIQUES AND EQUIPMENT] Confidence interval United Kingdom Discontinuation 030228 respiratory system Avaluació de resultats (Assistència sanitària) Human medicine business |
| Zdroj: | Scientia Respiratory research Respiratory Research Respiratory Research, Vol 22, Iss 1, Pp 1-14 (2021) |
| ISSN: | 1465-9921 |
| Popis: | Background Inhaled corticosteroids (ICS) are indicated for prevention of exacerbations in patients with COPD, but they are frequently overprescribed. ICS withdrawal has been recommended by international guidelines in order to prevent side effects in patients in whom ICS are not indicated. Method Observational comparative effectiveness study aimed to evaluate the effect of ICS withdrawal versus continuation of triple therapy (TT) in COPD patients in primary care. Data were obtained from the Optimum Patient Care Research Database (OPCRD) in the UK. Results A total of 1046 patients who withdrew ICS were matched 1:4 by time on TT to 4184 patients who continued with TT. Up to 76.1% of the total population had 0 or 1 exacerbation the previous year. After controlling for confounders, patients who discontinued ICS did not have an increased risk of moderate or severe exacerbations (adjusted HR: 1.04, 95% confidence interval (CI) 0.94–1.15; p = 0.441). However, rates of exacerbations managed in primary care (incidence rate ratio (IRR) 1.33, 95% CI 1.10–1.60; p = 0.003) or in hospital (IRR 1.72, 95% CI 1.03–2.86; p = 0.036) were higher in the cessation group. Unsuccessful ICS withdrawal was significantly and independently associated with more frequent courses of oral corticosteroids the previous year and with a blood eosinophil count ≥ 300 cells/μL. Conclusions In this primary care population of patients with COPD, composed mostly of infrequent exacerbators, discontinuation of ICS from TT was not associated with an increased risk of exacerbation; however, the subgroup of patients with more frequent courses of oral corticosteroids and high blood eosinophil counts should not be withdrawn from ICS. Trial registration European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (EUPAS30851). |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink