2020
DOI: 10.4187/respcare.07925
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Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation

Abstract: BACKGROUND: Although systemic corticosteroids (SCS) have long been used to treat patients with COPD exacerbation, the recommended dose remains controversial. We aimed to perform a meta-analysis and an indirect treatment comparison to investigate the efficacy and safety of different doses of SCS in subjects with COPD exacerbation. METHODS: Studies were identified by searching different databases for randomized controlled trials that investigated the efficacy and safety of SCS with placebo in subjects with exace… Show more

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Cited by 4 publications
(4 citation statements)
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“…This study found overall treatment to be similar regarding treatment failure within 90 days at rates of 56.3% and 61.7%, respectively 47 . This guidance has been corroborated in hospitalized and critical care patients with acute exacerbations of COPD 48–53 …”
Section: Chronic Obstructive Pulmonary Diseasesupporting
confidence: 55%
See 1 more Smart Citation
“…This study found overall treatment to be similar regarding treatment failure within 90 days at rates of 56.3% and 61.7%, respectively 47 . This guidance has been corroborated in hospitalized and critical care patients with acute exacerbations of COPD 48–53 …”
Section: Chronic Obstructive Pulmonary Diseasesupporting
confidence: 55%
“…47 This guidance has been corroborated in hospitalized and critical care patients with acute exacerbations of COPD. [48][49][50][51][52][53] More recently, eosinophilic-guided corticosteroid therapy has focused corticosteroid use in patients with COPD exacerbations exhibiting higher degrees of inflammation as measured by systemic eosinophilic counts. [54][55][56] The most robust of these trials used a threshold of greater than 300 cells/μL and found a reduction in median days of systemic corticosteroid exposure (2 [IQR 1-3] days in the eosinophilguided group vs. 5 [IQR 5-5] days in the control group, p < 0.0001) while demonstrating non-inferiority regarding days alive and out of the hospital.…”
Section: Clinical Evidencementioning
confidence: 99%
“… 17 Additionally, a recent meta-analysis compared clinical outcomes of patients treated for AECOPD. 32 Studies were enrolled in the meta-analysis if a specific dose of corticosteroid was compared against placebo, with studies being stratified as utilizing low, medium, or high corticosteroid doses. The low dose group was pre-specified as being 40 milligrams of prednisone per day or less, akin to current international guideline recommendations.…”
Section: Discussionmentioning
confidence: 99%
“…Including outpatients with COPD, a recent metaanalysis of randomized controlled trials showed that, compared with placebo, both low (# 40 mg) and high initial dosing (>100 mg) of oral corticosteroids had a lower risk of treatment failure with a low dose considered safer because a high dose had a significantly higher incidence of hyperglycemia. 8 Although the current study highlights the potential benefits of personalizing dose according to exacerbation phenotype, two important limitations are the composite primary end point of treatment failure and the open-label design. First, treatment failure included in-hospital additional treatment with corticosteroids or aminophylline or upgrade of antibiotics, mechanical ventilation or death, and postdischarge readmission within 180 days or death.…”
mentioning
confidence: 92%