Science and Research

"Real-life" inhaled corticosteroid withdrawal in COPD: a subgroup analysis of DACCORD

Many patients with chronic obstructive pulmonary disease (COPD) receive inhaled corticosteroids (ICSs) without a clear indication, and thus, the impact of ICS withdrawal on disease control is of great interest. DACCORD is a prospective, noninterventional 2-year study in the primary and secondary care throughout Germany. A subgroup of patients were taking ICS prior to entry - 1,022 patients continued to receive ICS for 2 years; physicians withdrew ICS on entry in 236 patients. Data from these two subgroups were analyzed to evaluate the impact of ICS withdrawal. Patients aged >/=40 years with COPD, initiating or changing COPD maintenance medication were recruited, excluding patients with asthma. Demographic and disease characteristics, prescribed COPD medication, COPD Assessment Test, exacerbations, and lung function were recorded. There were few differences in baseline characteristics; ICS withdrawn patients had shorter disease duration and better lung function, with 74.2% of ICS withdrawn patients not exacerbating, compared with 70.7% ICS-continued patients. During Year 1, exacerbation rates were 0.414 in the withdrawn group and 0.433 in the continued group. COPD Assessment Test total score improved from baseline in both groups. These data suggest that ICS withdrawal is possible with no increased risk of exacerbations in patients with COPD managed in the primary and secondary care.

  • Vogelmeier, C.
  • Worth, H.
  • Buhl, R.
  • Criee, C. P.
  • Lossi, N. S.
  • Mailander, C.
  • Kardos, P.

Keywords

  • Administration, Inhalation
  • Adrenal Cortex Hormones/*administration & dosage/adverse effects
  • Adult
  • Aged
  • Bronchodilator Agents/administration & dosage/adverse effects
  • Disease Progression
  • Drug Administration Schedule
  • Drug Combinations
  • Drug Therapy, Combination
  • Female
  • Germany
  • Humans
  • Lung/*drug effects/physiopathology
  • Male
  • Middle Aged
  • Primary Health Care
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive/diagnosis/*drug therapy/physiopathology
  • Recovery of Function
  • Registries
  • Risk Factors
  • Secondary Care
  • Time Factors
  • Treatment Outcome
  • COPD exacerbations
  • chronic obstructive pulmonary disease exacerbations
  • health-related quality of life
  • inhaled steroids
  • Menarini, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundipharma, Novartis,
  • and Takeda, and grants and personal fees from Grifols. HW reports personal fees
  • from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Klosterfrau,
  • Menarini, Novartis, and Takeda. RB reports personal fees from AstraZeneca,
  • Chiesi, GlaxoSmithKline, and Teva, and grants and personal fees from Boehringer
  • Ingelheim, Novartis, and Roche. C-PC reports personal fees from Boehringer
  • Ingelheim, Chiesi, GSK, Novartis, Takeda, and Berlin-Chemie. NSL is employed at
  • Novartis Pharma GmbH, Nurnberg, Germany, the sponsor of the study. CM is employed
  • at Novartis Pharma GmbH, Nurnberg, Germany, the sponsor of the study. PK reports
  • personal fees from Novartis, AstraZeneca, Boehringer Ingelheim, Chiesi, GSK,
  • Menarini, and Takeda. The authors report no other conflicts of interest in this
  • work.
Publication details
DOI: 10.2147/COPD.S125616
Journal: International journal of chronic obstructive pulmonary disease
Pages: 487-494 
Work Type: Original
Location: UGMLC
Disease Area: COPD
Partner / Member: UMR
Access-Number: 28203072
See publication on PubMed

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