Inhaled corticosteroids for stable chronic obstructive pulmonary disease

Yang, IA; Fong, KF; Black, Philippa M.

doi:10.1002/14651858.cd002991

Cited by 118 publications

(152 citation statements)

References 10 publications

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“…Neither prior responsiveness to steroids nor bronchial hyperreactivity (a cardinal feature of ICS‐responsive asthma) was assessed in the trial. However, none of these features have been demonstrated to be predictors of ICS response in COPD . Most patients in the trial were non‐atopics (64–69% in the individual treatment groups) as defined by a negative phadiatop test, and most had a long‐term history of smoking (average of more than 30 pack‐years in each treatment group).…”

Section: Discussionmentioning

confidence: 99%

“…Virtually all patients in the current trial responded to SABA, with a reversibility of more than 20% at screening. There is a belief that patients reversible to β 2 ‐adrenoceptor agonists are more prone to respond to ICS , but systematic reviews have failed to confirm this . On the contrary, several studies exploring ICS responsiveness identified patients with no or little reversibility to salbutamol to be responsive to ICS .…”

Section: Discussionmentioning

confidence: 99%

“…Current treatment guidelines in chronic obstructive pulmonary disease (COPD) recommend inhaled corticosteroids (ICS) in combination with inhaled long‐acting β 2 ‐adrenoceptor agonists (LABA) to treat patients with severe airflow limitation and/or COPD with a history of exacerbations . Arguably, the effect of anti‐inflammatory ICS in COPD remains controversial: To date, a small number of trials have shown ICS to slow down the accelerated decline in lung function typical of COPD , but systematic reviews on the use of ICS in COPD have failed to show this to be a true and reproducible effect . Systematic reviews demonstrate, however, a clear beneficial effect on exacerbation risk and quality of life .…”

mentioning

confidence: 99%

“…Arguably, the effect of anti‐inflammatory ICS in COPD remains controversial: To date, a small number of trials have shown ICS to slow down the accelerated decline in lung function typical of COPD , but systematic reviews on the use of ICS in COPD have failed to show this to be a true and reproducible effect . Systematic reviews demonstrate, however, a clear beneficial effect on exacerbation risk and quality of life . Also, many large and well‐controlled trials of long treatment duration have provided compelling evidence of improved lung function, reduction of symptoms and exacerbation frequency, as well as improved health‐related quality of life when ICS are added to bronchodilator treatment .…”

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confidence: 99%

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Efficacy and Tolerability of an Inhaled Selective Glucocorticoid Receptor Modulator – AZD5423 – in Chronic Obstructive Pulmonary Disease Patients: Phase II Study Results

Kuna

Aurivillius

Jorup

et al. 2017

Basic Clin Pharma Tox

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AZD5423 is a novel, inhaled, selective glucocorticoid receptor modulator (SGRM), which in an allergen challenge model in asthma patients improved lung function and airway hyper-reactivity. In the current trial, AZD5423 was for the first time tested in patients with chronic obstructive pulmonary disease (COPD). In this double-blind, randomized and parallel group study, we examined airway and systemic effects of two doses of AZD5423, inhaled via Turbuhaler for 12 weeks, in 353 symptomatic patients with COPD (average pre-bronchodilator forced expiratory volume in one-second (FEV1) at screening was 50-52% of predicted normal). Pre-bronchodilator FEV1 was primary variable, with other lung function parameters plus symptoms and 24-hr plasma cortisol being secondary variables. Plasma concentrations of AZD5423 were also measured. Effects were compared against placebo and a reference glucocorticoid receptor agonist control. Neither AZD5423, at doses which have shown to be efficacious in allergen-induced asthma, nor the reference control, at double the approved dose, had any clinically meaningful effect in the patient population studied in regard to lung function or markers of inflammation. Both GR modulators were well tolerated and did suppress 24-hr cortisol. This study suggests that the selected population of patients with COPD does not respond to treatment with AZD5423 as regards lung function, while showing the expected systemic effects. It cannot be ruled out that a favourable lung function response of AZD5423 can be evoked using another experimental setting and/or within a different population of patients with COPD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Efficacy and Tolerability of an Inhaled Selective Glucocorticoid Receptor Modulator – AZD5423 – in Chronic Obstructive Pulmonary Disease Patients: Phase II Study Results

Kuna

Aurivillius

Jorup

et al. 2017

Basic Clin Pharma Tox

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“…theophylline), and glucocorticoids. These treatments can be used singularly or in combination but fail to modify the factors that initiate and drive the long‐term progression of disease or infectious exacerbations/colonization 4–6 …”

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confidence: 99%