All patients entered a 6-week run-in period during which they received 18 μg of tiotropium once daily (delivered by a HandiHaler), 50 μg of salmeterol xinafoate twice daily (two actuations of 25 μg; a dose of 21 μg is designated on the U.S. product label), and 500 μg of fluticasone propionate (an inhaled glucocorticoid) twice daily (two actuations of 250 μg [U.S. designated dose, 230 μg] delivered by a metered-dose inhaler). The application and safety of ICS withdrawal remain controversial. 2017 Jun 21;12:1825-1836. doi: 10.2147/COPD.S129007. A new European Respiratory Society guideline has been published by the European Respiratory Journal that focuses on withdrawal of inhaled corticosteroids (ICS) in the treatment of chronic obstructive pulmonary disease (COPD).The document was developed in response to recent publications focused on ICS withdrawal as a potential therapeutic option for COPD … Unable to load your delegates due to an error GOLD denotes Global Initiative for Chronic Obstructive Lung Disease.Tap into groundbreaking research and clinically relevant insights 1. Chalmers JD, Laska IF, Franssen FME, et al. 2014 May 12;9:469-79. doi: 10.2147/COPD.S48492. Author information: (1)Department of Pulmonology, I.M. ), and the Department of Sports Medicine, University of Tübingen, Tübingen (K.T.) WISP: Withdrawal of inhaled corticosteroids in people with COPD in primary care.
Chest radiography was requested when pneumonia was suspected during the trial. Withdrawal of inhaled corticosteroids in COPD patients: rationale and algorithms. In the subgroup analysis of this study, patients with COPD were found to have … ).Panel A shows Kaplan–Meier curves for the estimated probability of moderate or severe exacerbations of chronic obstructive pulmonary disease (COPD) during the study, with no significant difference between the group assigned to withdrawal of inhaled glucocorticoids (IGC) and the group assigned to continued IGC treatment. Rank of the Mayo Clinic, Rochester, Minn., and his colleagues recently published a systematic review of the literature to answer this question (J. The horizontal lines indicate 95% confidence intervals. The first draft of the manuscript and subsequent revisions were written by the academic authors, and all the authors worked collaboratively to prepare the final content; all the authors made the decision to submit the manuscript for publication. The changes from baseline in the total SGRQ scores were an increase of 0.55 points in the glucocorticoid-withdrawal group and a reduction of 0.42 points in the glucocorticoid-continuation group at week 27 (P=0.08) and an increase of 1.15 and a decrease of 0.07, respectively, at week 52 (P=0.047).The overall proportion of patients who had one or more adverse events while receiving the study treatment was 71.2%, and the proportions were similar in the two groups (The incidence of pneumonia was 5.5% in the glucocorticoid-withdrawal group and 5.8% in the glucocorticoid-continuation group. eCollection 2017.Ferroni E, Belleudi V, Cascini S, Di Martino M, Kirchmayer U, Pistelli R, Patorno E, Formoso G, Fusco D, Perucci CA, Davoli M, Agabiti N; OUTPUL Study Group.J Clin Pharmacol. No change in dyspnea and minor changes in health status occurred in the glucocorticoid-withdrawal group.In patients with severe COPD receiving tiotropium plus salmeterol, the risk of moderate or severe exacerbations was similar among those who discontinued inhaled glucocorticoids and those who continued glucocorticoid therapy. BioMed Central — all in Germany; Servei de Pneumologia, Hospital Clínic–Institut d'Investigacions Biomèdiques August Pi i Sunyer–CIBERES, Universitat de Barcelona, Barcelona (R.R.-R.); the Departments of Clinical Research UK (L.T.)
Allergy Clin. 2017 Nov 28;18(1):198. doi: 10.1186/s12931-017-0682-y. Free PMC article We had 9 months of observation of patients who were not receiving glucocorticoids, with no suggestion that exacerbations were occurring more frequently. The document was developed in response to recent publications focused on ICS withdrawal as a potential therapeutic option for COPD using a personalised approach to treatment, including meta-analyses and other recommendations from the Global Initiative for Chronic Obstructive Lung Disease (The guideline task force included clinicians, researchers and patient advocates with COPD expertise. … At the investigator's discretion, randomized treatment could be discontinued and open-label fluticasone could be initiated for the remainder of the trial. Epub 2020 Jun 15.Souliotis K, Silva Miguel L, Hillas G, Borges M, Papageorgiou G, Viana D, Malhadeiro J, Soulard S.Ther Adv Respir Dis. ), Boehringer Ingelheim Pharma, Ingelheim (B.D., K.T.
The prespecified noninferiority margin of 1.20 was defined as the upper limit of the 95% confidence interval for the hazard ratio for the first moderate or severe exacerbation in the glucocorticoid-withdrawal group, as compared with the glucocorticoid-continuation group. We enrolled substantially more patients than were enrolled in all previous trials of glucocorticoid withdrawal combined, which allowed for further examination of the response in various subgroups.