Stepwise Glucocorticoid Withdrawal Feasible in COPD
(HealthDay News) — For patients with severe chronic obstructive pulmonary disease (COPD) receiving combination therapy with tiotropium, salmeterol, and glucocorticoids, the risk of exacerbations is similar for stepwise glucocorticoid withdrawal and continued glucocorticoid therapy, according to a study published online September 8 in the New England Journal of Medicine to coincide with the European Respiratory Society's International Congress, held September 6–10 in Munich.
Helgo Magnussen, MD, from the Lung Clinic Grosshansdorf in Germany, and colleagues conducted a 12-month study involving 2,485 patients with a history of COPD exacerbation. Participants received triple therapy (tiotropium, salmeterol, and inhaled fluticasone propionate) during a six-week run-in period and were then randomized to continue triple therapy or to undergo stepwise glucocorticoid withdrawal.
The researchers found that glucocorticoid withdrawal vs. continued use met the prespecified noninferiority criterion of 1.2 for the upper limit of the 95% confidence interval for the first moderate or severe COPD exacerbation (hazard ratio, 1.06; 95% confidence interval, 0.94–1.19). After completion of glucocorticoid withdrawal, the adjusted mean reduction from baseline in the trough forced expiratory volume in 1 second was greater in the glucocorticoid withdrawal group than the continued therapy group at week 18 (38ml) and at week 52 (43ml).
"A trial of glucocorticoid withdrawal will not increase the risk of exacerbation, even in patients with severe COPD," writes the author of an accompanying editorial.
Some study authors disclosed financial ties to pharmaceutical companies, including Boehringer Ingelheim, which funded the study.