Preventing exacerbations in chronic obstructive pulmonary disease (COPD) is one of the keys in the therapeutic strategy of this pathology because each of these adverse events makes the patient's health and prognosis worsen. Until now, the treatment in COPD as guidelines GOLD (Global Initiative for COPD) indicate consisted on a combination of long-acting bronchodilators with inhaled corticosteroids (ICS). The WISDOM trial (Withdrawal of Inhaled Steroids During Optimised bronchodilator Management) intends to reduce stepwise corticosteroids in patients with COPD and, as published by the NEJM, the results show that this change in treatment can be carried out without a higher risk of exacerbations or worsening neither symptoms nor quality of life of patients.
COPD is a disease that affects about 10% of the general population and especially smokers characterized by a limitation of the air flow and it is associated with an abnormal inflammatory response in the airways. Regarding to the treatment, there is a growing debate about the benefits and safety of long-term use of ICS in patients with the disease. Thus, the WISDOM study analyzed, involving about 2500 patients with severe to very severe COPD in stable clinical condition, the possibility of removing this medication gradually.
Patients were divided into two groups which were given the same basal medication (two long-acting bronchodilators and corticosteroids) and, while one of the groups maintained the triple therapy throughout the entire study, the other withdrew steroids in 3 steps over 12 weeks. After the 12 months of study, researchers found that this change in the treatment regimen did not influence the risk of new exacerbations. Besides, there was only a small decline in lung function at the final withdrawal step although it did not cause shortness of breath or a decrease in quality of life of patients.
Thus, the results of this study show for the first time that it is possible to remove inhaled corticosteroids in the treatment of patients with severe to very severe COPD without influence in future risk of new exacerbations, while treatment is maintained with two long-acting bronchodilators. This may mean, from now on, a change in the regular treatment of such patients.
Article reference:
Withdrawal of Inhaled Glucocorticoids and Exacerbations of COPD
Helgo Magnussen, M.D., Bernd Disse, M.D., Ph.D., Roberto Rodriguez-Roisin, M.D., Anne Kirsten, M.D., Henrik Watz, M.D., Kay Tetzlaff, M.D., Lesley Towse, B.Sc., Helen Finnigan, M.Sc., Ronald Dahl, M.D., Marc Decramer, M.D., Ph.D., Pascal Chanez, M.D., Ph.D., Emiel F.M. Wouters, M.D., Ph.D., and Peter M.A. Calverley, M.D. for the WISDOM Investigators
September 8, 2104DOI: 10.1056/NEJMoa1407154