Nguyen David, Larson Trent, Leinbach Heather, Guthrie Emily
Banner Desert Medical Center, Mesa, AZ, USA.
Hosp Pharm. 2021 Dec;56(6):786-791. doi: 10.1177/0018578720965417. Epub 2020 Oct 20.
To evaluate clinical outcomes and costs of inhaled corticosteroid (ICS) and systemic corticosteroid combination therapy versus systemic corticosteroid monotherapy for treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Hospitalized patients aged 41 to 85 years old who received ≥40 mg/day of systemic prednisone equivalents between April 3, 2017 to July 31, 2017 and April 3, 2018 to July 31, 2018 with a primary discharge diagnosis of AECOPD. Two cohorts were identified: those who received >2 doses of ICS (combination therapy) and those who received ≤2 doses of ICS (monotherapy) while on systemic corticosteroid therapy. Primary outcomes were progression of respiratory support or ≥20% increase in daily dose of systemic corticosteroids. Secondary outcomes were hospital length of stay (LOS), COPD 30-day readmissions, in-hospital mortality, and nebulized budesonide costs. One hundred twenty-eight patients met inclusion criteria. Daily corticosteroid dose increases were similar between the combination and monotherapy cohorts (4% vs. 5%, = 0.76) as was progression in ventilatory support (12% vs. 8%, = 0.53). In-hospital mortality (4% vs. 1%, = 0.36) and COPD 30-day readmissions (16% vs. 9%, = 0.22) were not significantly different, however, patients in the combination arm had longer lengths of stay (4.8 days vs. 3.9 days, = 0.04). Total nebulized budesonide costs were $1857 with a mean of $37 per patient stay for combination therapy cohort. Outcomes showed no clinical difference between combination therapy and monotherapy. This study suggests monotherapy may be more cost-effective while providing similar outcomes for the treatment of hospitalized patients with AECOPD.
评估吸入性糖皮质激素（ICS）与全身性糖皮质激素联合治疗与全身性糖皮质激素单药治疗在慢性阻塞性肺疾病急性加重期（AECOPD）治疗中的临床疗效和成本。纳入2017年4月3日至2017年7月31日以及2018年4月3日至2018年7月31日期间住院的41至85岁患者，这些患者接受相当于每日泼尼松≥40mg，且主要出院诊断为AECOPD。确定了两个队列：接受超过2剂ICS的患者（联合治疗组）和接受全身性糖皮质激素治疗时接受≤2剂ICS的患者（单药治疗组）。主要结局为呼吸支持的进展或全身性糖皮质激素每日剂量增加≥20%。次要结局为住院时间（LOS）、慢性阻塞性肺疾病30天再入院率、院内死亡率和雾化布地奈德成本。128例患者符合纳入标准。联合治疗组和单药治疗组之间每日糖皮质激素剂量增加相似（4%对5%，P = 0.76），通气支持进展情况也相似（12%对8%，P = 0.53）。院内死亡率（4%对1%，P = 0.36）和慢性阻塞性肺疾病30天再入院率（16%对9%，P = 0.22）无显著差异，然而，联合治疗组患者的住院时间更长（4.8天对3.9天，P = 0.04）。联合治疗组雾化布地奈德总成本为1857美元，每位患者住院期间平均成本为37美元。结果显示联合治疗与单药治疗之间无临床差异。本研究表明，对于住院的AECOPD患者，单药治疗可能在提供相似疗效的同时更具成本效益。
