In hospitalized patients with severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD), individuals who were prescribed a 2- to 5-day systemic corticosteroid regimen had more favorable outcomes than those prescribed a 14-day regimen. Pooled individual patient data from 2 investigator-initiated, noninferiority trials — REDUCE and CORTICO-COP — were analyzed. Results of the current study were published in the journal Respiratory Research.
The researchers sought to evaluate the number of days alive and out of the hospital in patients with AECOPD, based on data from the REDUCE and CORTICO-COP multicenter, randomized trials (ISRCTN19646069 and ClinicalTrials.gov Identifier: NCT02857842, respectively). In REDUCE, investigators compared a short-term (5-day) treatment regimen with a conventional (14-day) systemic corticosteroid regimen in 314 participants. In the nationwide, prospective CORTICO-COP trial, investigators assessed eosinophil-guided corticosteroid treatment for AECOPD in 318 individuals.
The primary outcome was days alive and out of the hospital within 14 days after study recruitment. Secondary outcomes included (1) length of hospital stay, (2) rate of hospital discharge within 30 days, (3) all-cause mortality during 6-month follow-up, (4) a combined endpoint of intensive care unit (ICU) admission and all-cause mortality, and (5) newly diagnosed or aggravation of preexisting hypertension.
Patients in the 14-day treatment regimen group were older, with fewer individuals having received antibiotic pretreatment and more participants having been pretreated with systemic corticosteroids.
Results of the study showed that the number of days alive and spent out of the hospital within 14 days of study recruitment was significantly longer in the 2- to 5-day treatment group than in the 14-day group (mean, 8.4 days; 95% CI, 8.0-8.8 vs mean, 4.2 days, 95% CI, 3.4-4.9, respectively; P <.001). Furthermore, the 14-day AECOPD group had significantly longer hospital stays (mean difference, 5.4±0.6 days; P <.0001) and a significantly decreased likelihood of hospital discharge within 30 days (hazard ratio [HR], 0.5; 95% CI, 0.4-0.6; P <.0001).
During the 6-month follow-up period, no statistically significant differences were reported between the 2 regimens with respect to the composite endpoint of ICU admission and death (odds ratio [OR], 1.4; 95% CI, 0.8-2.3; P =.15), risk for morality (HR, 0.8; 95% CI, 0.4-1.5; P =.45), or new or aggravated hypertension (OR, 1.5; 95% CI, 0.9-2.7; P =.15).
The researchers concluded that additional prospective studies on this topic are warranted to validate the findings from this study. Although those participants who were randomly assigned to a 2- to 5-day systemic corticosteroid treatment regimen demonstrated more favorable primary outcomes, which were driven by their substantially shorter hospital admission durations, the possibility that these results are related to factors other than the corticosteroid dose administered cannot be excluded.
Sivapalan P, Rutishauser J, Ulrik CS, et al. Effect of different corticosteroid regimes for hospitalised patients with exacerbated COPD: pooled analysis of individual participant data from the REDUCE and CORTICO-COP trials. Respir Res. 2021;22(1):155. doi:10.1186/s12931-021-01745-5