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Am J Respir Crit Care Med. 2006 Jun 15;173(12):1356-62. Epub 2006 Mar 23.

Multicenter randomized controlled trial of withdrawal of inhaled corticosteroids in cystic fibrosis.

Author information

1
Department of Paediatric Respiratory Medicine, Royal Brompton & Harefield NHS Trust, and National Heart & Lung Institute, Imperial College London, SW3 6NP, UK. i.balfourlynn@ic.ac.uk

Abstract

RATIONALE:

Lung inflammation and injury is critical in cystic fibrosis. An ideal antiinflammatory agent has not been identified but inhaled corticosteroids are widely used despite lack of evidence.

OBJECTIVES:

To test the safety of withdrawal of inhaled corticosteroids with the hypothesis this would not be associated with an earlier onset of acute chest exacerbations.

METHODS:

Multicenter randomized double-blind placebo-controlled trial in 18 pediatric and adult UK centers. Eligibility criteria included age>6.0 yr, FEV1>or=40% predicted, and corticosteroid use>3 mo. During the 2-mo run-in period, all patients received fluticasone; they then took either fluticasone or placebo for 6 mo.

MEASUREMENTS AND MAIN RESULTS:

Fluticasone group: n=84, median age 14.6 yr, mean (SD) FEV1 76% (18); placebo group: n=87, median age 15.8 yr, mean (SD) FEV1 76% (18). There was no difference in time to first exacerbation (primary outcome) with hazard ratio (95% confidence interval) of 1.07 (0.68 to 1.70) for fluticasone versus placebo. There was no effect of age, atopy, corticosteroid dose, FEV1, or Pseudomonas aeruginosa status. There was no change in lung function or differences in antibiotic or rescue bronchodilator use. Fewer patients in the fluticasone group withdrew from the study due to lung-related adverse events (9 vs. 15%); with a relative risk (95% confidence interval) of 0.59 (0.23-1.48) fluticasone versus placebo.

CONCLUSIONS:

In this study population (applicable to 40% of patients with cystic fibrosis in the UK), it appears safe to consider stopping inhaled corticosteroids. Potential advantages will be to reduce the drug burden on patients, reduce adverse effects, and make financial savings.

PMID:
16556691
DOI:
10.1164/rccm.200511-1808OC
[Indexed for MEDLINE]
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