🏅 Conference Winning Abstract
A systematic review of withdrawal of inhaled corticosteroids from patients with COPD: effect on exacerbation frequency and lung function, and proportion who resume ICS treatment. (ID 440)
King's College London
Funding: None.
Abstract
Background: ICS therapy has been demonstrated to reduce the risk of exacerbations but should only be prescribed to COPD patients with ≥2 exacerbations per year and a blood eosinophil count ≥ 300µg/L, who aren't adequately controlled by LABA/LAMA therapy (2023 GOLD Report, n.d.). However, ICS therapy is prescribed outside guidelines in COPD patients, making ICS withdrawal an important consideration. This systematic review (SR) aims to provide an up-to-date analysis on the proportion of COPD patients who resume ICS following withdrawal, and to examine the effect of ICS withdrawal on the exacerbation frequency and on changes in lung function (FEV1).Method: This SR included RCTs and observational cohort studies (OCSs) which compared ICS withdrawal vs. ICS continuation treatment arms. The databases searched included OVID Medline, Embase, Cochrane Central, CINHAL and Web of Science. Risk of bias was assessed using the Cochrane RoB2 tool and the Newcastle-Ottawa Scale, and quality assessment was conducted using GRADE.
Results: 14 RCTs and 14 OCSs were included in the results. There was insufficient evidence to draw a conclusion on the proportion of patients who resumed ICS therapy following withdrawal. When ICS was withdrawn but therapy with LABA or LAMA, or both, was maintained, there was no significant difference in exacerbation frequency or lung function between the ICS withdrawal and ICS continuation arms of the trials.
Discussion: This SR supports the safety and feasibility of ICS withdrawal from COPD patients. Previous SRs support the findings of this review, that when withdrawing ICS from COPD patients it's important to maintain bronchodilation therapy for optimal outcomes. There was evidence of a statistically significant decline in lung function in the ICS withdrawal groups vs. ICS continuation, but this was not clinically significant. Further research could identify the specific subgroup of COPD patients from whom ICS withdrawal would not be indicated.
Conflicts of interest: None.
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