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Oral or IV Prednisolone in the Treatment of COPD Exacerbations^*

A Randomized, Controlled, Double-blind Study

^* From the Department of Pulmonology (Drs. de Jong, Grotjohan, and van den Berg, and Mr. Uil), Isala Klinieken, Zwolle, the Netherlands; and the Department of Pulmonology (Drs. Postma and Kerstjens), University Medical Center Groningen, Groningen, the Netherlands.

Correspondence to: Ynze P. de Jong, MD, Isala klinieken, Pulmonology, PO Box 10500, Zwolle 8000 GM, the Netherlands; e-mail: y.p.de.jong{at}isala.nl

Abstract

Background: Treatment with systemic corticosteroids for exacerbations of COPD results in improvement in clinical outcomes. On hospitalization, corticosteroids are generally administered IV. It has not been established whether oral administration is equally effective. We conducted a study to demonstrate that therapy with oral prednisolone was not inferior to therapy with IV prednisolone using a double-blind, double-dummy design.

Methods: Patients hospitalized for an exacerbation of COPD were randomized to receive 5 days of therapy with prednisolone, 60 mg IV or orally. Treatment failure, the primary outcome, was defined as death, admission to the ICU, readmission to the ICU because of COPD, or the intensification of pharmacologic therapy during a 90-day follow-up period.

Results: A total of 435 patients were referred for a COPD exacerbation warranting hospitalization; 107 patients were randomized to receive IV therapy, and 103 to receive oral therapy. Overall treatment failure within 90 days was similar, as follows: IV prednisolone, 61.7%; oral prednisolone, 56.3% (one-sided lower bound of the 95% confidence interval [CI], –5.8%). There were also no differences in early (ie, within 2 weeks) treatment failure (17.8% and 18.4%, respectively; one-sided lower bound of the 95% CI, –9.4%), late (ie, after 2 weeks) treatment failure (54.0% and 47.0%, respectively; one-sided lower bound of the 95% CI, –5.6%), and mean (± SD) length of hospital stay (11.9 ± 8.6 and 11.2 ± 6.7 days, respectively). Over 1 week, clinically relevant improvements were found in spirometry and health-related quality of life, without significant differences between the two treatment groups.

Conclusion: Therapy with oral prednisolone is not inferior to IV treatment in the first 90 days after starting therapy. We suggest that the oral route is preferable in the treatment of COPD exacerbations.

Trial registration: Clinicaltrials.gov Identifier: NCT00311961.

Key Words: COPD • exacerbation • IV prednisolone • oral prednisolone

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