Best medications for COPD exacerbations? A new meta-analysis

  • Dobler CC & al.
  • Ann Intern Med
  • 25 Feb 2020

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • A meta-analysis of 68 randomized controlled trials (RCTs) finds that systemic antibiotics and corticosteroids are associated with fewer treatment failures than placebo.
  • Systemic antibiotics are also associated with a greater likelihood of exacerbation resolution.
  • Exacerbation severity did not affect these results.

Why this matters

  • This is one of the first comparative meta-analyses of its kind.
  • Findings support the use of corticosteroids or antibiotics for mild to severe exacerbations but not other medications.

Study design

  • A meta-analysis of 68 RCTs (n>10,700 adults in out-patient or in-patient facilities).
  • Funding: US Agency for Healthcare Research and Quality.

Key results

  • Regardless of exacerbation severity, antibiotics vs placebo or management without antibiotics were associated with:
    • Better exacerbation resolution after a 3-14-day trial:
      • OR, 2.03 (95% CI, 1.47-2.80); and
    • Less treatment failure:
      • OR, 0.54 (95% CI, 0.34-0.86).
  • Systemic corticosteroids vs placebo in out- and in-patients for 9-56 days were associated with less treatment failure (OR, 0.01; 95% CI, 0.00-0.13), regardless of exacerbation severity.
  • They were, however, linked to a greater number of total and endocrine-related adverse events.
  • The evidence was insufficient for other interventions, such as aminophyllines, magnesium sulfate, anti-inflammatories, inhaled corticosteroids, and short-acting bronchodilators.

Limitations

  • No head-to-head comparisons of individual medications.