■吸入皮质类固醇(ICS)治疗已被证明可以降低COPD加重的风险。应仅适用于未通过双重长效支气管扩张剂治疗得到充分控制且每年加重≥2次,血液嗜酸性粒细胞计数≥300个细胞/µL的COPD患者。ICS治疗在COPD患者的指南之外广泛使用,使ICS退出成为一个重要的考虑因素。本系统综述旨在对ICS戒断对加重频率的影响进行最新分析。肺功能(FEV1)的变化,并确定停药后恢复ICS治疗的COPD患者的比例。
■纳入比较ICS停药与ICS继续治疗的随机对照试验(RCT)和观察性研究。CochraneCentral,WebofScience,CINHAL,搜索Embase和OVIDMedline。使用CochraneRoB2工具和纽卡斯尔-渥太华量表评估偏倚风险。采用GRADE对随机对照试验进行质量评价。ICS戒断RCT事后分析的荟萃分析,通过血液嗜酸性粒细胞计数(BEC)分层,进行了。
■10项随机对照试验(6642例患者随机分组)和6项观察性研究(160,029例患者)纳入结果。当停用ICS并维持长效支气管扩张剂治疗时,ICS退出试验组和继续试验组的加重频率或肺功能变化无一致差异.这些影响的证据质量中等。对于停药后恢复ICS治疗的患者比例(估计范围为12-93%的参与者),没有足够的证据得出确切的结论。
COPD患者退出ICS治疗是安全可行的,但应同时维持支气管扩张治疗以获得最佳结果。
UNASSIGNED: Inhaled corticosteroid (ICS) therapy has been demonstrated to reduce the risk of COPD exacerbations. It should only be prescribed to COPD patients who are not adequately controlled by dual long-acting bronchodilator therapy and who have ≥2 exacerbations per year and a blood eosinophil count ≥300cells/µL. ICS therapy is widely prescribed outside guidelines to COPD patients, making ICS withdrawal an important consideration. This systematic
review aims to provide an up-to-date analysis of the effect of ICS withdrawal on exacerbation frequency, change in
lung function (FEV1) and to determine the proportion of COPD patients who resume ICS therapy following withdrawal.
UNASSIGNED: Randomised controlled trials (RCTs) and observational studies which compared ICS withdrawal with ICS continuation treatment were included. Cochrane Central, Web of Science, CINHAL, Embase and OVID Medline were searched. Risk of bias was assessed using the Cochrane RoB2 tool and the Newcastle-Ottawa Scale. Quality assessment of RCTs was conducted using GRADE. Meta-analysis of post-hoc analyses of RCTs of ICS withdrawal, stratified by blood eosinophil count (BEC), was undertaken.
UNASSIGNED: Ten RCTs (6642 patients randomised) and 6 observational studies (160,029 patients) were included in the results. When ICS was withdrawn and long-acting bronchodilator therapy was maintained, there was no consistent difference in exacerbation frequency or
lung function change between the ICS withdrawal and continuation trial arms. The evidence for these effects was of moderate quality. There was insufficient evidence to draw a firm conclusion on the proportion of patients who resumed ICS therapy following withdrawal (estimated range 12-93% of the participants).
UNASSIGNED: Withdrawal of ICS therapy from patients with COPD is safe and feasible but should be accompanied by maintenance of bronchodilation therapy for optimal outcomes.