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Meta-Analysis
. 2023 Dec 29;18(12):e0296470.
doi: 10.1371/journal.pone.0296470. eCollection 2023.

Long- versus short-duration systemic corticosteroid regimens for acute exacerbations of COPD: A systematic review and meta-analysis of randomized trials and cohort studies

Zhen Zhao  1 , Owen Lou  2 , Yiyang Wang  3 , Raymond Yin  1 , Carrie Gong  4 , Florence Deng  2 , Ethan C Wu  5 , Jing Yi Xie  2 , Jerry Wu  3 , Avery Ma  6 , Yongzhi Guo  7 , Wei Ting Xiong  7
Affiliations
Meta-Analysis

Long- versus short-duration systemic corticosteroid regimens for acute exacerbations of COPD: A systematic review and meta-analysis of randomized trials and cohort studies

Zhen Zhao et al. PLoS One. .

Abstract

While systemic corticosteroids quicken patient recovery during acute exacerbations of COPD, they also have many adverse effects. The optimal duration of corticosteroid administration remains uncertain. We performed a systematic review and meta-analysis to compare patient outcomes between short- (≤7 days) and long- (>7 days) corticosteroid regimens in adults with acute exacerbations of COPD. MEDLINE, EMBASE, CENTRAL, and hand searches were used to identify eligible studies. Risk of bias was assessed using the Cochrane RoB 2.0 tool and ROBINS-I. Data were summarized as ORs (odds ratios) or MDs (mean differences) whenever possible and qualitatively described otherwise. A total of 11532 participants from eight RCTs and three retrospective cohort studies were included, with 1296 from seven RCTs and two cohort studies eligible for meta-analyses. Heterogeneity was present in the methodology and settings of the studies. The OR (using short duration as the treatment arm) for mortality was 0.76 (95% CI = 0.40-1.44, n = 1055). The MD for hospital length-of-stay was -0.91 days (95% CI = -1.81--0.02 days, n = 421). The OR for re-exacerbations was 1.31 (95% CI = 0.90-1.90, n = 552). The OR for hyperglycemia was 0.90 (95% CI = 0.60-1.33, n = 423). The OR for infection incidence was 0.96 (95% CI = 0.59-1.156, n = 389). The MD for one-second forced expiratory volume change was -18.40 mL (95% CI = -111.80-75.01 mL, n = 161). The RCTs generally had low or unclear risks of bias, while the cohort studies had serious or moderate risks of bias. Our meta-analyses were affected by imprecision due to insufficient data. Some heterogeneity was present in the results, suggesting population, setting, and treatment details are potential prognostic factors. Our evidence suggests that short-duration treatments are not worse than long-duration treatments in moderate/severe exacerbations and may lead to considerably better outcomes in milder exacerbations. This supports the current GOLD guidelines. Trial registration: Our protocol is registered in PROSPERO: CRD42023374410.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow chart outlining the search and selection process.
Fig 2
Fig 2. Comparison of mortality risk between short- (≤7 days) and long- (>7 days) duration regimens of corticosteroids.
Fig 3
Fig 3. Comparison of hospital length-of-stay between short- (≤7 days) and long- (>7 days) duration regimens of corticosteroids.
Fig 4
Fig 4. Comparison of re-exacerbation risk between short- (≤7 days) and long- (>7 days) duration regimens of corticosteroids.
Fig 5
Fig 5. Comparison of hyperglycemia risk between short- (≤7 days) and long- (>7 days) duration regimens of corticosteroids.
Fig 6
Fig 6. Comparison of hyperglycemia risk between short- (≤7 days) and long- (>7 days) duration regimens of corticosteroids.
Fig 7
Fig 7. Comparison of FEV1 change between short- (≤7 days) and long- (>7 days) duration regimens of corticosteroids.
See this image and copyright information in PMC

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