A recent study evaluated whether a short-term 5-day systemic glucocorticoid treatment in patients with chronic obstructive pulmonary disease (COPD) exacerbation is noninferior to a conventional 14-day treatment.2 This randomized, multicenter, placebo-controlled, double-blind trial was conducted from March 2006 through February 2011 in 5 Swiss teaching hospitals and studied patients (n = 314) presenting to the emergency department with acute COPD exacerbation and past or present smokers (≥20 pack-years) without a history of asthma. Patients were randomized to receive prednisone 40 mg daily for either 5 or 14 days. The primary outcome was time to next exacerbation within 180 days, and the predefined noninferiority criterion was an absolute increase in exacerbations of, at most, 15%, translating to a critical hazard ratio of 1.515, for a reference event rate of 50%.
Results showed that noninferiority criteria were met. Hazard ratios for the short-term versus conventional treatment group were 0.95 (90% CI, 0.70-1.29; P = .006 for noninferiority) in the intention-to-treat analysis and 0.93 (90% CI, 0.68 -1.26; P = .005 for noninferiority) in the per protocol analysis. In the short-term (5-day) treatment group, 56 patients (35.9%) reached the primary end point compared with 57 (36.8%) in the conventional (14-day) treatment group. The median time to event for re-exacerbation was 43.5 days (interquartile range [IQR], 13 to 118) in the short-term group and 29 days (IQR, 16 to 85) in the conventional group. The authors concluded that this study supports the use of a 5-day glucocorticoid treatment in acute exacerbations of COPD due to noninferiority to a conventional treatment course and reduction in glucocorticoid exposure.
Dr. Reed is a freelance writer in Fairless Hills, Pennsylvania.