Systemic corticosteroid for COPD exacerbations, whether the higher dose is better? A meta-analysis of randomized controlled trials

BackgroundSystemic corticosteroids (SCS) have been shown to improve the outcome of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the optimal dose remains controversial. ObjectivesWe performed a meta-analysis to evaluate whether high-dose SCS is better. MethodsWe searched PubMed, EMBASE, CPCI-S and CENTRAL databases, and references of reviews or meta-analyses to identify randomized controlled trials using SCS in AECOPD. We performed a routine meta-analysis to evaluate the effects of SCS on treatment failure rate and forced expiratory volume in 1s (FEV1) improvement compared with placebo in AECOPD. Subgroup analysis was performed by dividing the studies into a high-dose group [initial dose 80mg prednisone equivalent (PE)/day] and a low-dose group (initial dose 30-80mg PE/day) in all patients and in only inpatients. Meta-regression was performed using initial dose as an independent factor. We classified the suspected adverse effects into several groups and combined them separately. ResultsOur search yielded 12 studies involving 1172 patients. SCS use was associated with a significant reduction in the treatment failure rate [risk ratio 0.58; 95% confidence interval (CI): 0.46-0.73] and improvement in FEV1 (0.11L; 95% CI: 0.08-0.14L). The high-dose regimen did not show superiority to the low-dose regimen. No obvious correlation was found between the SCS effect and the initial dose. SCS led to an obvious increase in hyperglycemia risk. However, the high-dose group did not show obviously higher risk of adverse effects. ConclusionSCS can reduce treatment failure rate and improve lung function in AECOPD. The low-dose regimen (initial dose 30-80mg/day PE) is proper for treating AECOPD.