The risk of asthma exacerbation after stopping low-dose inhaled corticosteroids: A systematic review and meta-analysis of randomized controlled trials - 27/02/13
Abstract |
Background |
Current asthma guidelines suggest that patients and their providers consider decreasing or stopping controller medications when asthma is stable.
Objective |
We sought to estimate the risk of asthma exacerbation in patients who stop low-dose inhaled corticosteroids (ICSs) compared with those who continue ICSs in randomized controlled trials.
Methods |
We identified relevant trials from a systematic review of English-language and non–English-language articles using MEDLINE, EMBASE, and CENTRAL (inception to January 21, 2012). Articles were screened at the abstract and full-text level by 2 independent reviewers. We included randomized controlled trials with a stable asthma run-in period of 4 weeks or more, an intervention to stop or continue ICSs, and a follow-up period of at least 3 months. We pooled results using a random-effects meta-analysis.
Results |
The search strategy identified 1798 potential articles, of which 172 were reviewed at the full-text level and 7 met the criteria for inclusion. The relative risk for an asthma exacerbation in patients who stopped ICSs compared with those who continued use was 2.35 (95% CI, 1.88-2.92; P < .001; I2 = 0%), as determined by using data pooled from trials with a mean follow-up of 27 weeks. The pooled absolute risk difference for an asthma exacerbation was 0.23 (95% CI, 0.16-0.30; P < .001; I2 = 44%). Patients who discontinued ICSs also had a decreased FEV1 of 130 mL (95% CI, 40-210 mL; P = .003; I2 = 53%), a decreased mean morning peak expiratory flow of 18 L/min (95% CI, 6-29 L/min; P = .004; I2 = 82%), and an increased mean standardized asthma symptom score of 0.43 SDs (95% CI, 0.28-0.58 SDs; P < .001; I2 = 0%).
Conclusion |
Patients with well-controlled asthma who stop regular use of low-dose ICSs have an increased risk of an asthma exacerbation compared with those who continue ICSs.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, antiasthma agents, glucocorticoids, clinical trial, step down, withdraw, discontinue, decrease, wean, cessation
Abbreviations used : ICS, LABA, NAEPP, PEF, PRISMA, RR
Plan
Supported by the Mayo Foundation. |
|
Disclosure of potential conflict of interest: M. A. Rank is employed by the Mayo Clinic. J. B. Hagan is the Dyac Chairman of Adjudication panel for KALBITOR; has received research support from the National Heart, Lung, and Blood Institute, National Institute of Allergy and Infectious Diseases, MedImmune, and the Mayo Foundation; is inventor of technology to assess asthma therapy adherence; and previously owned stock in Johnson & Johnson and Teva. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 131 - N° 3
P. 724 - mars 2013 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?