5 Days vs 14 Days of Steroids for COPD Exacerbations: The REDUCE Trial
Currently, guidelines advocate for systemic steroid therapy in the management of acute exacerbations of COPD. Multiple randomized clinical trials have shown the benefits on clinical outcomes of COPD (Reduction of LOS and quicker recovery of FEV1). The optimal dose and duration for COPD is not really known. Furthermore, long-term use of glucocorticoids can cause osteoporosis, diabetes mellitus, and most importantly is a risk factor for increased mortality in COPD.
What is the REDUCE Trial?
- REDuction in the Use of Corticosteroids in Exacerbated COPD
What they did:
- Randomized Placebo Controlled, Double Blind, Non-Inferiority Multicenter Trial
- 5 Swiss Teaching Hospitals
- 314 patients with COPD
- Treatment with 40mg of prednisone daily for 5 days versus 14 days
- Time to next exacerbation within 180 days
- Exacerbation rate 35.9% (short term treatment) vs 36.8% (conventional treatment)
- Median time to exacerbation 43.5 days (short term treatment) vs 29 days (conventional treatment)
- No difference in mortality
- No increase in need for mechanical ventilation between treatment regimens
- Hypertension developed or worsened in 11.6% (short term treatment) vs 17.8% (conventional treatment)
- No difference in hyperglycemia in the two groups
- All patients, regardless of GOLD classification were treated with inhaled long-acting Beta-agonists, glucocorticoids, and tiotropium
- All patients received antibiotic treatment regardless of sputum production or procalcitonin level
- Most of the patients in this study had severe or very severe COPD
Conclusion: 5-day treatment with systemic glucocorticoids is non-inferior to 14 day treatment and significantly reduces glucocorticoid exposure
In my opinion, how will this affect your practice?
- Patients in this study were over-treated with antibiotics, which is not the standard of care for hospitalized patients.
- A 5-day treatment regimen is non-inferior to a 14 day regimen of glucocorticoids
- It may be reasonable to treat patients with 5 days of glucocorticoids for COPD exacerbations
Dr. Salim R. Rezaie is a physician at the University of Texas Health Science Center at San Antonio. He is double board-certified in Emergency Medicine and Internal Medicine.