Pragmatic trial on inhaled corticosteroid withdrawal in patients with COPD in general practice

Abstract

The therapeutic value of inhaled corticosteroids (ICSs) for COPD is limited. In published RCTs, ICS could be withdrawn in COPD patients without increasing exacerbation risk when bronchodilator treatment is optimized. Here we report on the feasibility and risks of ICS withdrawal in Dutch general practice for COPD patients without an indication for ICSs. In our pragmatic trial, general practitioners decided autonomously which of their COPD patients on ICS treatment could stop this, how this was done, and whether additional bronchodilator therapy was needed. We recruited 62 COPD patients (58 analysed) who were eligible for ICS withdrawal in 79 practices. In 32 patients (55.2%, 95% CI: 42.5–67.3%) ICS was withdrawn successfully, 19 (32.8%, 95% CI: 22.1–45.6%) restarted ICS treatment within six months, 12 patients (20.7%, 95% CI: 12.3–32.8%) had a moderate exacerbation, and one patient had a severe exacerbation. ICS withdrawal was successful in just over half of the patients with COPD without an indication for ICS.

Treatment of COPD Groups GOLD A and B with Inhaled Corticosteroids in the COSYCONET Cohort – Determinants and Consequences

“…Regarding outcome measures, the use of ICS was associated with better generic quality of life as measured by the EQ-VAS scale, in line with findings showing a deterioration of EQ-VAS in patients undergoing ICS withdrawal. 37 This is remarkable, as among our ICS patients of GOLD groups A/B 72% also received LABA/LAMA, ie a potent bronchodilator combination. Unfortunately, only 87 patients received ICS monotherapy or a combination with LAMA or LABA, and therefore, numbers were too low to draw reliable conclusions for patients with ICS but not triple therapy.…”

“…This assumption was in accordance with data showing that in the general practitioner setting, ICS treatment was re-initiated after withdrawal mainly due to respiratory symptoms. 37 …”

Triple therapy in a single inhaler for chronic obstructive pulmonary disease: clinical studies and case report (real practice)

“…Одно из них проведено в Нидерландах, где изучались последствия перехода на двой ную бронходилатацию у 58 пациентов, наблюдавшихся у врачей общей практики и получавших тройную терапию без достаточных на то оснований (по мнению врачей). Это небольшое исследование показало, что даже у пациентов, получающих ИГКС без достаточных оснований, успешность отмены этой терапевтической группы отмечалась лишь у 55%немногим более чем у половины испытуемых [16].…”