Withdrawal of inhaled corticosteroids in COPD: A meta-analysis

Luigino Calzetta, Maria Gabriella Matera, Fulvio Braido, Marco Contoli, Angelo Corsico, Fabiano Di Marco, Pierachille Santus, Nicola Scichilone, Mario Cazzola, Paola Rogliani

Research output: Contribution to journalArticle

Abstract

Background Conflicting findings exist on the benefit of withdrawal of inhaled corticosteroid (ICS) in chronic obstructive pulmonary disease (COPD). We performed a quantitative synthesis in order to assess real impact of ICS discontinuation in COPD patients. Methods We carried out a meta-analysis via random-effects model on the available clinical evidence to evaluate the effect of ICS discontinuation in COPD. Randomized clinical trials and observational real-life studies investigating the effects of ICS withdrawal on the risk of COPD exacerbation, lung function (forced expiratory volume in 1 s [FEV1]) and quality of life (St. George's Respiratory Questionnaire [SGRQ]) were identified by searching from published studies and repository databases. Results ICS withdrawal did not significantly (P > 0.05) increase the overall rate of COPD exacerbation, although a clinically important increased risk of severe exacerbation was detected (Relative Risk >1.2). ICS withdrawal significantly (P < 0.001) impaired both lung function (−30 ml FEV1) and quality of life (+1.24 SGRQ units), although in a non-clinically important manner. The time to the first exacerbation was significantly (P < 0.05) shorter in the patients who discontinued ICS. Conclusions The discrepancy between statistical analysis and clinical interpretation of this meta-analytic evaluation demonstrates the strong clinical need in understanding what is the real impact of ICS withdrawal in COPD. ICS discontinuation is a complex procedure that requires a well planned and tailored strategy. Further well designed studies on withdrawal of ICS should be performed by clustering COPD patients with regard to the phenotype characteristics, rate of exacerbations/year, decline of lung function, and quality of life.

Original languageEnglish
Pages (from-to)148-158
Number of pages11
JournalPulmonary Pharmacology and Therapeutics
Volume45
DOIs
Publication statusPublished - Aug 1 2017

Keywords

  • Chronic obstructive pulmonary disease
  • Inhaled corticosteroids
  • Withdrawal

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Biochemistry, medical
  • Pharmacology (medical)

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  • Cite this

    Calzetta, L., Matera, M. G., Braido, F., Contoli, M., Corsico, A., Di Marco, F., Santus, P., Scichilone, N., Cazzola, M., & Rogliani, P. (2017). Withdrawal of inhaled corticosteroids in COPD: A meta-analysis. Pulmonary Pharmacology and Therapeutics, 45, 148-158. https://doi.org/10.1016/j.pupt.2017.06.002