Table 1 Studies of inhaled corticosteroid (ICS) withdrawal in patients with chronic obstructive pulmonary disease
Author, year (study name) | Study design; duration | Study population | Treatment | Main findings |
|---|---|---|---|---|
Jarad, 1999 [58] | MC, observational study; 8 weeks | COPD, post-BD FEV1 < 70% predicted (n = 272) | ICS withdrawal vs no previous ICS therapy | Increased risk of exacerbation after ICS withdrawal |
van der Valk, 2002 (COPE) [59] | R, DB, SC, PC trial;4-month ICS run-in,6-month active treatment | Moderate-to-severe COPD, pre-BD FEV1 25–80% predicted, no exacerbations in past month (n = 244) | FP/IB vs PBO+ IB | Higher risk of exacerbation and deterioration in QoL after ICS withdrawal |
Wouters, 2005 (COSMIC) [60] | R, DB, PG, MC trial; 3-month ICS/LABA run-in, 1-year active treatment | Moderate-to-severe COPD, pre-BD FEV1 30–70% predicted, ≥2 exacerbations in past year (n = 373) | FP/Sal vs Sal alone | Deterioration of symptoms and lung function after ICS withdrawal; no difference in the rate of exacerbations |
Choudhury, 2007 (WISP) [61] | R, DB, PC trial; 2 week run-in on usual ICS; 1-year treatment | Primary care, moderate-to-severe COPD, post-BD FEV1 < 80% predicted, no exacerbations in past month(n = 260) | FP vs PBO | Higher risk of exacerbations and symptom deterioration after ICS withdrawal; no differences in lung function or QoL |
Magnussen, 2014 (WISDOM) [63] | R, DB, PG, MC trial; 6-week ICS/LABA/LAMA run-in; 12-month active treatment | Severe-to-very severe COPD, FEV1 < 50%, ≥1 exacerbation in past year (n = 2485) | FP/Sal/Tio vs Sal/Tio + stepwise FP withdrawal | No differences in symptoms or exacerbations rate; significantly greater decrease in lung function with complete ICS withdrawal |
Rossi, 2014 (INSTEAD) [65] | R, DB, DD, PG trial; 2-week ICS/LABA run-in; 26-week active treatment | Moderate COPD, GOLD stage II, no exacerbations in the past year (n = 581) | Switching from FP/Sal to Ind vs continuing FP/Sal | No differences in exacerbations, symptoms, lung function, QoL |
Rossi, 2014 (OPTIMO) [66] | Prospective, real-life study; 6-month observation period | Mild-to-moderate COPD, on ICS + LABA for 1 year, FEV1 > 50%, <2 exacerbations in past year (n = 914) | ICS/LABA vs mainly LABD (91% LABA ± LAMA; 9% SABD ± theophylline) | ICS withdrawal not associated with worsening of exacerbation rates, lung function or symptoms |
Suissa, 2015 [68] | Population-based, observational study; 4.9 years of follow-up | COPD treated with ICS (n = 103,386) | ICS withdrawal | Significant 37% reduction in serious pneumonia after ICS withdrawal; greatest reduction after FP withdrawal |
Vogelmeier, 2013 (ILLUMINATE) [48] | R, DB, DD, PG, MC trial; 26 weeks | Moderate-to-severe COPD, GOLD stages II–III, no exacerbations in past year (n = 523) | Ind/Gly vs FP/Sal | Significantly improved lung function with Ind/Gly |
Zhong, 2015 (LANTERN) [49] | R, DB, DD, PG, MC trial; 26 weeks | Moderate-to-severe COPD, GOLD stage II–III, ≤1 exacerbation in past year (n = 744) | Ind/Gly vs FP/Sal | Significantly reduced exacerbations and improved lung function with Ind/Gly; incidence of pneumonia 3-fold lower with Ind/Gly |
Wedzicha, 2016 (FLAME) [50] | R, DB, DD, PG, MC trial; 4-week Tio run-in; 52-week active treatment | Moderate-to-severe COPD, post-BD FEV1 25–60% predicted, ≥1 exacerbation in past year (n = 3362) | Ind/Gly vs FP/Sal | Lower annual rate of exacerbation and longer time to first exacerbation with Ind/Gly; incidence of pneumonia higher with FP/Sal |
Vogelmeier, 2017 (CRYSTAL) [69] | R, OL, MC trial; 12 weeks | Moderate COPD, ≤1 exacerbation in past year, on ICS/LABA, LABA, or LAMA therapy (n = 4389) | Switching to Gly or Ind/Gly vs continuing baseline therapy | Improved lung function and dyspnea with Ind/Gly vs ongoing ICS/LABA, LABA, or LAMA therapy |