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

Abstract

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 There were few differences in baseline characteristics; ICS withdrawn patients had shorter disease duration and better lung function, with 74.2% of ICS withdrawn patients not exacerbating, compared with 70.7% ICS-continued patients. During Year 1, exacerbation rates were 0.414 in the withdrawn group and 0.433 in the continued group.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.

Keywords:

• COPD exacerbations
• chronic obstructive pulmonary disease exacerbations
• health-related quality of life
• inhaled steroids

Acknowledgments

The authors thank the investigators and patients at the investigative sites for their support of this study.

Writing support was provided by David Young of Young Medical Communications and Consulting Ltd. This support included the development of the first draft of the manuscript, under the guidance of the authors, and the coordination of author comments and approval, and was funded by Novartis Pharma GmbH. This study was funded by Novartis Pharma GmbH.

Disclosure

CV reports personal fees from Almirall, AstraZeneca, Berlin-Chemie – 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, Nürnberg, Germany, the sponsor of the study. CM is employed at Novartis Pharma GmbH, Nürnberg, 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.