Reduction of Corticosteroid Use in Outpatient Treatment of Exacerbated COPD

  • STATUS
    Recruiting
  • End date
    Dec 7, 2022
  • participants needed
    470
  • sponsor
    Prof. Dr. Jörg Leuppi
Updated on 7 August 2021
antibiotics
corticosteroids
prednisone
dyspnea
obstruction
cough
forced expiratory volume
airway obstruction
bronchiectasis
acute exacerbation of chronic obstructive pulmonary disease

Summary

Background

Chronic obstructive pulmonary disease (COPD) is a major public health issue with no curative treatment. In Switzerland estimated 5-7% of the total population are suffering from this chronic disease. According to current guidelines corticosteroids are part of treatment of acute exacerbations in COPD patients. Several studies suggest that corticosteroids accelerate the recovery of forced expiratory volume in 1 second (FEV1), decrease duration of hospitalization, reduce treatment failure rate and improve clinical outcome. The additional therapeutic benefit on FEV1-recovery tough seems only to last for three to five days. The investigators recently published a hospital-based study showing that in patients presenting to emergency departments with acute exacerbation of COPD, a short five day treatment with systemic steroids was not inferior to a conventional 14 day treatment with regard to re-exacerbation. Cumulative corticosteroid dose could be reduced in this trial. To the investigators knowledge no data is available about the minimal necessary corticosteroid dose in an outpatient treatment setting so far.

Aim

The primary aim of this study is to investigate in an outpatient setting, whether a three day treatment with orally administered systemic corticosteroids is non-inferior to a five day treatment in acute exacerbation of COPD and if total glucocorticoid exposure can be reduced by shorter therapy.

Hypothesis

The investigators postulate, that in an outpatient setting, where generally less severe exacerbations are being treated, a three day treatment duration of systemic corticosteroids should be non-inferior to a five day treatment duration with regard to treatment benefits but decrease cumulative corticosteroid exposure.

Design and Setting

This study is going to be performed as a prospective, randomized, double-blind, placebo-controlled, non-inferiority trial in an outpatient setting. Randomization will be performed as block randomization with a 1:1 allocation. The investigators are going to recruit GPs in northwestern and central Switzerland.

Methods

The investigators are going to include patients presenting to GP's with acute exacerbation of COPD. When matching the investigators eligibility criteria and written informed consent is given, patients included in the study are receiving systemic corticosteroid treatment (equivalent of 40mg prednisone daily) for either five days (conventional arm) or three days (interventional arm) followed by two days of placebo for the interventional group. Pre-randomized, identically looking, numbered blisters are given to all patients included in the study. Antibiotic treatment (Amoxicillin/Clavulanic acid, 625mg 3/d, for ten days) is given to all patients with a CRP 50mg/l, COPD and known diagnosis of bronchiectasis, as well as patients presenting with all three of the following symptoms: change of baseline dyspnea, change of sputum quantity and sputum purulence. Further initial treatment and steroid treatment after inclusion is determined and documented by the GP. Patients will undergo follow-up visits at day three and seven by their GP as well as follow-up phone calls executed by the study center at day 30, 90 and 180.

Details
Condition Chronic Obstructive Lung Disease, Disease Progression, COPD (Chronic Obstructive Pulmonary Disease), Adverse Effect of Glucocorticoids and Synthetic Analogues
Treatment prednisone, Placebo
Clinical Study IdentifierNCT02386735
SponsorProf. Dr. Jörg Leuppi
Last Modified on7 August 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Informed Consent as documented by signature
Age 40 years
History of 10 pack-years of smoking (past or present smokers)
Airway obstruction, defined as FEV1/FVC70%
Current acute exacerbation of COPD by clinical criteria, defined by the presence of at least two of the following
Change of baseline dyspnea
Change of cough
Change of sputum quantity or purulence

Exclusion Criteria

Diagnosis of asthma
Initial necessity of hospitalization
Women who are pregnant or breast feeding
Premenopausal women with insufficient contraception and anamnestic risk for pregnancy
Severe coexisting disease with life expectancy <6 months
Diagnosis of tuberculosis
Known severe immunosuppression or immunosuppression after solid organ or stem cell transplantation
Inability to follow study procedures, e.g. due to language problems, psychological disorders, dementia, etc. of the participant
Participation in another study involving an investigational drug
Previous enrolment into the current study
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