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Research ArticleReviews

Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation

Xiaofeng Pu, Liang Liu, Bimin Feng, Maolin Wang, Limei Dong, Zhengji Zhang, Qingze Fan, Ying Li and Guojun Wang
Respiratory Care October 2020, respcare.07925; DOI: https://doi.org/10.4187/respcare.07925
Xiaofeng Pu
Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Clinical Pharmacy, School of Pharmacy, Southwest Medical University, Luzhou, China.
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Liang Liu
Department of Clinical Pharmacy, School of Pharmacy, Southwest Medical University, Luzhou, China.
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Bimin Feng
Department of Clinical Pharmacy, School of Pharmacy, Southwest Medical University, Luzhou, China.
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Maolin Wang
Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Limei Dong
Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Zhengji Zhang
Department of Clinical Pharmacy, School of Pharmacy, Southwest Medical University, Luzhou, China.
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Qingze Fan
Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Ying Li
Department of Clinical Pharmacy, School of Pharmacy, Southwest Medical University, Luzhou, China.
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Guojun Wang
Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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  • For correspondence: [email protected]
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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 exacerbation of COPD. The different doses of SCS were assigned to low-dose (ie, initial dose ≤ 40 mg prednisone equivalent/d [PE/d]), medium-dose (initial dose = 40–100 mg PE/d, and high-dose (initial dose > 100 mg PE/d) groups. The indirect treatment comparison was performed between low-, medium-, and high-dose SCS groups.

RESULTS: Twelve trials with 1,375 participates were included. Compared to placebo, the risk of treatment failure was lower in the low-dose SCS groups (risk ratio 0.61 [95% CI 0.43–0.88], P = .007) and high-dose SCS groups (risk ratio 0.64 [95% CI 0.48–0.85], P = .002); the FEV1 was significantly improved in low-dose (mean difference 0.09 [95% CI 0.06–0.12], P < .001), medium-dose (mean difference 0.23 [95% CI 0.02–0.44], P = .036), and high-dose SCS groups (mean difference 0.09, [95% CI 0.03–0.15], P < .001, respectively). Regarding safety, the incidence of hyperglycemia was higher in high-dose SCS groups versus placebo (risk ratio 2.52 [95% CI 1.13–5.62], P = .02). The indirect comparison between low-, medium-, and high-dose SCS found that the risk of treatment failure and changes in FEV1 were similar between these doses of SCS.

CONCLUSIONS: This meta-analysis indicates that low-dose SCS (initial dose ≤ 40 mg PE/d) was sufficient and safer for treating subjects with COPD exacerbation, and it was noninferior to higher doses of SCS (initial dose > 40 mg PE/d) in improving FEV1 and reducing the risk of treatment failure. However, our findings need to be verified in head-to-head randomized controlled trials.

  • COPD exacerbation
  • systemic corticosteroids
  • different doses
  • meta-analysis
  • indirect treatment comparison

Footnotes

  • Correspondence: Guojun Wang MSc, Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, 25 Taiping St, Luzhou, Sichuan 646000, China. E-mail: renren333{at}126.com.
  • Mr Pu and Mr Liu are co-first authors.

  • Copyright © 2020 by Daedalus Enterprises

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Respiratory Care: 66 (3)
Respiratory Care
Vol. 66, Issue 3
1 Mar 2021
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Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation
Xiaofeng Pu, Liang Liu, Bimin Feng, Maolin Wang, Limei Dong, Zhengji Zhang, Qingze Fan, Ying Li, Guojun Wang
Respiratory Care Oct 2020, respcare.07925; DOI: 10.4187/respcare.07925

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Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation
Xiaofeng Pu, Liang Liu, Bimin Feng, Maolin Wang, Limei Dong, Zhengji Zhang, Qingze Fan, Ying Li, Guojun Wang
Respiratory Care Oct 2020, respcare.07925; DOI: 10.4187/respcare.07925
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Keywords

  • COPD exacerbation
  • systemic corticosteroids
  • different doses
  • meta-analysis
  • indirect treatment comparison

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