Dutch researchers found no advantage for IV steroids.
Patients hospitalized for chronic obstructive pulmonary disease exacerbations often receive IV corticosteroids. In this randomized, double-blind trial, researchers in the Netherlands examined whether IV therapy offers any advantage over oral therapy in 210 patients hospitalized for COPD exacerbations; those with severe respiratory acidosis were excluded.
Patients received either IV or oral prednisolone (60 mg daily) plus corresponding placebos for 5 days, followed by a week of tapering oral prednisolone. At 90 days, no differences between groups were observed in the composite primary outcome — death, intensive care unit admission, readmission to the hospital for COPD, or predefined intensification of treatment. Early treatment failure (within 2 weeks) and late treatment failure (between 2 weeks and 3 months) occurred with similar frequency in the two groups. Among a subgroup of patients who had already received outpatient oral steroids prior to admission, IV steroids still conferred no advantage during hospitalization.
Comment: This study shows rather convincingly that oral steroids work as well as IV steroids in patients with COPD exacerbations who require hospitalization (but not ICU admission). The findings are not surprising, given the high bioavailability of prednisone and prednisolone after oral administration.
Published in Journal Watch General Medicine January 2, 2008
de Jong YP et al. Oral or IV prednisolone in the treatment of COPD exacerbations: A randomized, controlled, double-blind study. Chest 2007 Dec; 132:1741.