Doxycycline for outpatient-treated acute exacerbations of COPD: a randomised double-blind placebo-controlled trial

Velzen, Patricia van; Riet, Gerben ter; Bresser, Paul; Baars, Jeroen J; Berg, Bob; Berg, Jan Willem K. van den; Brinkman, Paul; Dagelet, J.W.F.; Daniëls, Hans; Groeneveld-Tjiong, Dewi R G L; Jonkers, René E.; Kan, Coen van; Krouwels, Frans H.; Pool, K. R. S.; Rudolphus, Arjan; Sterk, Peter J.; Prins, Jan M.

doi:10.1016/s2213-2600(17)30165-0

Cited by 49 publications

(56 citation statements)

References 19 publications

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“…The rationale for performing this economic evaluation was that in retrospective studies, fewer subsequent exacerbations were observed in patients treated with antibiotics during exacerbations [12,13], and we hypothesised that total costs might be lower in the doxycycline group as compared to the placebo group. In addition, although we found a non-statistically significant difference in short-term treatment failure rates in previous research (odds ratio 0.8; 95% CI 0.41-1.60) [16], we speculated that doxycycline might reduce the number of hospitalisations. As hospitalisations are the key drivers of costs in exacerbations [35], doxycycline would still be cost-effective and therefore justify antibiotic prescription.…”

Section: Discussioncontrasting

confidence: 85%

“…Fourth, this study was based on a randomised controlled trial powered to detect differences in time to the next exacerbation and not QALYs. Although this might be one explanation for doxycycline's lack of effectiveness, the consistency between our results and the clinical results reported in van Velzen et al [16] suggests that this is unlikely.…”

Section: Discussionsupporting

confidence: 80%

“…Participants, investigators and those assessing outcomes were blinded to intervention assignment. Full details of the trial are available in Van Velzen et al [16].…”

Section: Trial Designmentioning

confidence: 99%

“…Recently, a randomised controlled trial conducted by the current research group investigated the long-term clinical effectiveness of doxycycline versus placebo added to prednisolone for the treatment of COPD exacerbations in an outpatient setting [16]. Differently from what it was hypothesised, it found that treatment with antibiotics did not prolong time to the next exacerbation.…”

Section: Introductionmentioning

confidence: 96%

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Doxycycline Added to Prednisolone in Outpatient-Treated Acute Exacerbations of COPD: A Cost-Effectiveness Analysis Alongside a Randomised Controlled Trial

Finch¹,

Velzen

Riet

et al. 2018

PharmacoEconomics

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Background Most patients with mild to severe chronic obstructive pulmonary disease (COPD) experience exacerbations, which are also associated with increased healthcare costs. Despite limited evidence of antibiotics' benefits for exacerbations in outpatients, antibiotics are frequently prescribed. The aim of this study was to investigate whether doxycycline added to prednisolone is cost-effective compared to placebo plus prednisolone for the treatment of COPD acute exacerbations. Methods An economic evaluation from the societal perspective was performed alongside a 2-year randomised trial in 301 COPD patients in the Netherlands. The primary outcome was cost per quality-adjusted life year (QALY). The secondary outcome was cost per exacerbation prevented. Healthcare utilisation and loss of productivity were measured using retrospective questionnaires and clinical report forms. Missing data were imputed using multiple imputations by chained equations. Bootstrapping was employed to estimate statistical uncertainty surrounding cost-effectiveness outcomes. A sensitivity analysis from the healthcare perspective was performed. Results On average, costs in the doxycycline group were €898 higher than in the placebo group [95% confidence interval (CI) − 2617 to 4409] for the 2 years of follow-up. QALY values were higher in the doxycycline group (0.03; 95% CI − 0.00 to 0.06), but patients in this group suffered 0.01 more exacerbations than patients in the placebo group (95% CI − 0.14 to 0.11). Cost-effectiveness acceptability curves showed that the probability of doxycycline being cost-effective compared to placebo was 61% and 43% at a willingness-to-pay threshold of €34,000 per QALY and per exacerbation avoided, respectively. The sensitivity analysis showed similar results from the healthcare system perspective. Conclusions In patients with mild to severe COPD treated for exacerbations in an outpatient setting, doxycycline added to prednisolone is not cost-effective compared to prednisolone plus placebo over a 2-year period. Aureliano Paolo Finch and Patricia van Velzen equally contributed to this work.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionsupporting

confidence: 80%

“…Participants, investigators and those assessing outcomes were blinded to intervention assignment. Full details of the trial are available in Van Velzen et al [16].…”

Section: Trial Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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Doxycycline Added to Prednisolone in Outpatient-Treated Acute Exacerbations of COPD: A Cost-Effectiveness Analysis Alongside a Randomised Controlled Trial

Finch¹,

Velzen

Riet

et al. 2018

PharmacoEconomics

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“…A possible, long-term prophylactic effect of antibiotics given to patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) in the outpatient setting has been investigated in a randomised controlled trial 1 . Although antibiotics are recommended for some patients for the management of acute exacerbations, systematic reviews and clinical trials have shown conflicting results 2–4 .…”

mentioning

confidence: 99%

Does doxycycline delay the next COPD exacerbation?

2017

DTB

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Antibiotics for exacerbations of chronic obstructive pulmonary disease

Vollenweider¹,

Frei

Steurer-Stey

et al. 2018

Cochrane Database of Systematic Reviews

102

108

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Background Many patients with an exacerbation of chronic obstructive pulmonary disease (COPD) are treated with antibiotics. However, the value of antibiotics remains uncertain, as systematic reviews and clinical trials have shown conflicting results. Objectives To assess e ects of antibiotics on treatment failure as observed between seven days and one month a er treatment initiation (primary outcome) for management of acute COPD exacerbations, as well as their e ects on other patient-important outcomes (mortality, adverse events, length of hospital stay, time to next exacerbation).

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Doxycycline for outpatient-treated acute exacerbations of COPD: a randomised double-blind placebo-controlled trial

Cited by 49 publications

References 19 publications

Doxycycline Added to Prednisolone in Outpatient-Treated Acute Exacerbations of COPD: A Cost-Effectiveness Analysis Alongside a Randomised Controlled Trial

Doxycycline Added to Prednisolone in Outpatient-Treated Acute Exacerbations of COPD: A Cost-Effectiveness Analysis Alongside a Randomised Controlled Trial

Does doxycycline delay the next COPD exacerbation?

Antibiotics for exacerbations of chronic obstructive pulmonary disease

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