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Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study Magnussen, Helgo Lucas, Sarah Lapperre, Therese Quint, Jennifer K. Dandurand, Ronald J. Roche, Nicolas Miravitlles Fernández, Marc Institut Català de la Salut [Magnussen H] Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North, Member of the German Center of Lung Research, Grosshansdorf, Germany. [Lucas S] Respiratory Efectiveness Group, Ely, UK. [Lapperre T] Department of Respiratory Medicine, Antwerp University Hospital, Edegem, Denmark. Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Wilrijk, UK. [Quint JK] Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Wilrijk, UK. [Dandurand RJ] CIUSSS de L’Ouest de L’Île de Montréal, Montreal Chest Institute, Meakins Christie Laboratories, Oscillometry Unit and Centre for Innovative Medicine, McGill University Health Centre and Research Institute, Montreal, QC, Canada. [Miravitlles M] Servei de Pneumologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus Pulmons - Malalties obstructives - Tractament Avaluació de resultats (Assistència sanitària) DISEASES::Respiratory Tract Diseases::Lung Diseases::Lung Diseases, Obstructive::Pulmonary Disease, Chronic Obstructive Other subheadings::Other subheadings::Other subheadings::/drug therapy ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome ENFERMEDADES::enfermedades respiratorias::enfermedades pulmonares::enfermedades pulmonares obstructivas::enfermedad pulmonar obstructiva crónica Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento MPOC; Eficàcia; Corticoides inhalats EPOC; Eficacia; Corticosteroides inhalados COPD; Effectiveness; Inhaled corticosteroids Background Inhaled corticosteroids (ICS) are indicated for prevention of exacerbations in patients with COPD, but they are frequently overprescribed. ICS withdrawal has been recommended by international guidelines in order to prevent side effects in patients in whom ICS are not indicated. Method Observational comparative effectiveness study aimed to evaluate the effect of ICS withdrawal versus continuation of triple therapy (TT) in COPD patients in primary care. Data were obtained from the Optimum Patient Care Research Database (OPCRD) in the UK. Results A total of 1046 patients who withdrew ICS were matched 1:4 by time on TT to 4184 patients who continued with TT. Up to 76.1% of the total population had 0 or 1 exacerbation the previous year. After controlling for confounders, patients who discontinued ICS did not have an increased risk of moderate or severe exacerbations (adjusted HR: 1.04, 95% confidence interval (CI) 0.94–1.15; p = 0.441). However, rates of exacerbations managed in primary care (incidence rate ratio (IRR) 1.33, 95% CI 1.10–1.60; p = 0.003) or in hospital (IRR 1.72, 95% CI 1.03–2.86; p = 0.036) were higher in the cessation group. Unsuccessful ICS withdrawal was significantly and independently associated with more frequent courses of oral corticosteroids the previous year and with a blood eosinophil count ≥ 300 cells/μL. Conclusions In this primary care population of patients with COPD, composed mostly of infrequent exacerbators, discontinuation of ICS from TT was not associated with an increased risk of exacerbation; however, the subgroup of patients with more frequent courses of oral corticosteroids and high blood eosinophil counts should not be withdrawn from ICS. The study was funded by a Grant from Boehringer Ingelheim. 2021-05-27T10:01:26Z 2021-05-27T10:01:26Z 2021-01-21 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Magnussen H, Lucas S, Lapperre T, Quint JK, Dandurand RJ, Roche N, et al. Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study. Respir Res. 2021 Jan 21;22:25. 1465-993X https://hdl.handle.net/11351/5986 10.1186/s12931-021-01615-0 33478491 000612880800001 http://hdl.handle.net/11351/5986 eng Respiratory Research;22 https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-021-01615-0 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf BMC Scientia