A descriptive cohort study of withdrawal from inhaled corticosteroids in COPD patients
Abstract Inhaled corticosteroid (ICS) therapy is widely prescribed without a history of exacerbations and consensus guidelines suggest withdrawal of ICS in these patients would reduce the risk of side effects and promote cost-effective prescribing. The study describes the prescribing behaviour in th...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2022-07-01
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| Series: | npj Primary Care Respiratory Medicine |
| Online Access: | https://doi.org/10.1038/s41533-022-00288-6 |
| _version_ | 1811287144506851328 |
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| author | Smit Patel Scott Dickinson Kevin Morris Helen F. Ashdown James D. Chalmers |
| author_facet | Smit Patel Scott Dickinson Kevin Morris Helen F. Ashdown James D. Chalmers |
| author_sort | Smit Patel |
| collection | DOAJ |
| description | Abstract Inhaled corticosteroid (ICS) therapy is widely prescribed without a history of exacerbations and consensus guidelines suggest withdrawal of ICS in these patients would reduce the risk of side effects and promote cost-effective prescribing. The study describes the prescribing behaviour in the United Kingdom (UK) in relation to ICS withdrawal and identifies clinical outcomes following withdrawal using primary and secondary care electronic health records between January 2012 and December 2017. Patients with a history ≥12 months’ exposure who withdrew ICS for ≥6 months were identified into two cohorts; those prescribed a long-acting bronchodilator maintenance therapy and those that were not prescribed any maintenance therapy. The duration of withdrawal, predictors of restarting ICS, and clinical outcomes were compared between both patient cohorts. Among 76,808 patients that had ≥1 prescription of ICS in the study period, 11,093 patients (14%) withdrew ICS therapy at least once during the study period. The median time without ICS was 9 months (IQR 7–14), with the majority (71%) receiving subsequent ICS prescriptions after withdrawal. Patients receiving maintenance therapy with a COPD review at withdrawal were 28% less likely to restart ICS (HR: 0.72, 95% CI 0.61, 0.85). Overall, 69% and 89% of patients that withdrew ICS had no recorded exacerbation event or COPD hospitalisation, respectively, during the withdrawal. This study provides evidence that most patients withdrawing from ICS do not experience COPD exacerbations and withdrawal success can be achieved by carefully planning routine COPD reviews whilst optimising the use of available maintenance therapies. |
| first_indexed | 2024-04-13T03:13:32Z |
| format | Article |
| id | doaj.art-d6b09c0a077e4f6884fce2334f191593 |
| institution | Directory Open Access Journal |
| issn | 2055-1010 |
| language | English |
| last_indexed | 2024-04-13T03:13:32Z |
| publishDate | 2022-07-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Primary Care Respiratory Medicine |
| spelling | doaj.art-d6b09c0a077e4f6884fce2334f1915932022-12-22T03:04:59ZengNature Portfolionpj Primary Care Respiratory Medicine2055-10102022-07-0132111110.1038/s41533-022-00288-6A descriptive cohort study of withdrawal from inhaled corticosteroids in COPD patientsSmit Patel0Scott Dickinson1Kevin Morris2Helen F. Ashdown3James D. Chalmers4Boehringer Ingelheim LtdBoehringer Ingelheim LtdBoehringer Ingelheim LtdNuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory QuarterScottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical SchoolAbstract Inhaled corticosteroid (ICS) therapy is widely prescribed without a history of exacerbations and consensus guidelines suggest withdrawal of ICS in these patients would reduce the risk of side effects and promote cost-effective prescribing. The study describes the prescribing behaviour in the United Kingdom (UK) in relation to ICS withdrawal and identifies clinical outcomes following withdrawal using primary and secondary care electronic health records between January 2012 and December 2017. Patients with a history ≥12 months’ exposure who withdrew ICS for ≥6 months were identified into two cohorts; those prescribed a long-acting bronchodilator maintenance therapy and those that were not prescribed any maintenance therapy. The duration of withdrawal, predictors of restarting ICS, and clinical outcomes were compared between both patient cohorts. Among 76,808 patients that had ≥1 prescription of ICS in the study period, 11,093 patients (14%) withdrew ICS therapy at least once during the study period. The median time without ICS was 9 months (IQR 7–14), with the majority (71%) receiving subsequent ICS prescriptions after withdrawal. Patients receiving maintenance therapy with a COPD review at withdrawal were 28% less likely to restart ICS (HR: 0.72, 95% CI 0.61, 0.85). Overall, 69% and 89% of patients that withdrew ICS had no recorded exacerbation event or COPD hospitalisation, respectively, during the withdrawal. This study provides evidence that most patients withdrawing from ICS do not experience COPD exacerbations and withdrawal success can be achieved by carefully planning routine COPD reviews whilst optimising the use of available maintenance therapies.https://doi.org/10.1038/s41533-022-00288-6 |
| spellingShingle | Smit Patel Scott Dickinson Kevin Morris Helen F. Ashdown James D. Chalmers A descriptive cohort study of withdrawal from inhaled corticosteroids in COPD patients npj Primary Care Respiratory Medicine |
| title | A descriptive cohort study of withdrawal from inhaled corticosteroids in COPD patients |
| title_full | A descriptive cohort study of withdrawal from inhaled corticosteroids in COPD patients |
| title_fullStr | A descriptive cohort study of withdrawal from inhaled corticosteroids in COPD patients |
| title_full_unstemmed | A descriptive cohort study of withdrawal from inhaled corticosteroids in COPD patients |
| title_short | A descriptive cohort study of withdrawal from inhaled corticosteroids in COPD patients |
| title_sort | descriptive cohort study of withdrawal from inhaled corticosteroids in copd patients |
| url | https://doi.org/10.1038/s41533-022-00288-6 |
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