Personalized- better than fixed-dose steroid dosing for COPD exacerbations

In the treatment of hospitalized chronic obstructive pulmonary disorder (COPD) patients with exacerbations, personalized-dose corticosteroid dosing is more effective than fixed-dose, as reported in a study.

A total of 248 patients were randomized to receive systemic corticosteroid at either fixed dose (40 mg prednisolone equivalent; n=124) or personalized dose (n=124) for 5 days. One patient in each group was excluded from the intention-to-treat (ITT) population because of incorrect initial COPD diagnosis.

The primary endpoint of a composite measure of treatment failure, which included in-hospital treatment failure and medium-term (postdischarge) failure, occurred with less frequency in the personalized-dose than in the fixed-dose group (27.6 percent vs 48.8 percent; relative risk [RR], 0.40, 95 percent confidence interval [CI], 0.24–0.68; p=0.001).

When assessed individually, the in-hospital failure of therapy was likewise lower in the personalized-dose group (10.6 percent vs 24.4 percent; p=0.005), whereas the medium-term failure rate was similar.

There were no between-group differences seen in the adverse event rate, hospital length of stay, and costs.

Following treatment failure, patients in the personalized-dose vs fixed-dose group required a lower additional dose of corticosteroids and a shorter duration of treatment to achieve control of the exacerbation. In the personalized cohort, those receiving ≤40 mg had an average failure rate of 44.4 percent as compared to 22.9 precent among those who received >40 mg (p=0.027).