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COPD: Is Stepping Down Therapy Safe?

The results of a recent trial, published in The New England Journal of Medicine,that studied the gradual withdrawal of inhaled glucocorticoids and exacerbations of chronic obstructive pulmonary disease (COPD) found that there was a “significant decrease in lung function with completion of glucocorticoid withdrawal at week 18, which persisted to the end of the 12-month trial.”

The trial included 2,485 patients with a history of frequent COPD exacerbations on tiotropium (Spiriva), salmeterol (Serevent), and fluticasone for an initial 6-week period. Patients were randomly assigned to continued triple therapy or withdrawal of fluticasone over a 12-week period.

Those who continued withdrawal to week 18 saw a “greater decrease in lung function.” The results of those who continued triple therapy were “not clinically meaningful,” meaning the changes in exacerbations were not significant enough to count against the final results.

In an accompanying editorial, John J. Reilly, MD, University of Pittsburgh Pulmonary Division, concluded that "the results of this trial, taken together with the findings of other studies, suggest that the rationale for continuing glucocorticoid therapy in patients who are also taking long-acting bronchodilators should be based on symptomatic improvement attributable to the glucocorticoid rather on the prevention of exacerbations."

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