Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 7, Ground Floor, DK-2900, Hellerup, Denmark.
Department of Internal Medicine, Zealand Hospital, University of Copenhagen, Roskilde, Denmark.
Respir Res. 2020 Oct 12;21(1):263. doi: 10.1186/s12931-020-01531-9.
Long-term treatment with corticosteroids causes loss of bone density, but the effects of using short-term high-dose systemic-corticosteroid therapy to treat acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are unclear. Our aim was to determine whether high-dose corticosteroid therapy affected bone turnover markers (BTMs) to a greater extent compared to low-dose corticosteroid therapy.
The CORTICO-COP trial (NCT02857842) showed that an eosinophil-guided corticosteroid intervention led to approximately 60% lower accumulated corticosteroid dose for hospitalized patients with AECOPD (low-dose group) compared with 5-day standard corticosteroid treatment (high-dose group). We compared the levels of BTMs C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP) in 318 participants during AECOPD and at 1- and 3-month follow-up visits.
CTX decreased and P1NP increased significantly over time in both treatment groups. There were no significant differences between the groups at 1- or 3-months follow-up for P1NP. A significant drop in CTX was seen at 3 months (down Δ24% from the baseline, p = 0.017) for the high dose group.
Short-term, high-dose systemic corticosteroid treatment caused a rapid suppression of biomarkers of bone resorption. Corticosteroids did not suppress biomarkers of bone formation, regardless of patients receiving low or high doses of corticosteroids. This therapy was, therefore, harmless in terms of bone safety, in our prospective series of COPD patients.
ClinicalTrials.gov Identifier: NCT02857842 . Submitted August 2nd, 2016.
长期使用皮质类固醇会导致骨密度下降，但短期大剂量全身皮质类固醇治疗慢性阻塞性肺疾病急性加重（AECOPD）的效果尚不清楚。我们的目的是确定高剂量皮质类固醇治疗是否比低剂量皮质类固醇治疗更能影响骨转换标志物（BTMs）。
CORTICO-COP 试验（NCT02857842）表明，嗜酸粒细胞指导的皮质类固醇干预使住院 AECOPD 患者（低剂量组）的累积皮质类固醇剂量比 5 天标准皮质类固醇治疗（高剂量组）降低了约 60%。我们比较了 318 名参与者在 AECOPD 期间以及在 1 个月和 3 个月随访时的 BTMs 1 型胶原 C 端肽（CTX）和前胶原 1 N 端前肽（P1NP）的水平。
CTX 在两组中均随时间显著下降，P1NP 显著升高。在 1 个月或 3 个月的随访时，两组之间 P1NP 没有差异。高剂量组在 3 个月时 CTX 显著下降（从基线下降 24%，p=0.017）。
短期、大剂量全身皮质类固醇治疗迅速抑制骨吸收的生物标志物。无论患者接受低剂量还是高剂量的皮质类固醇，皮质类固醇都不会抑制骨形成的生物标志物。因此，在我们前瞻性的 COPD 患者系列中，这种治疗在骨安全性方面是无害的。
ClinicalTrials.gov 标识符：NCT02857842。提交日期 2016 年 8 月 2 日。
