Prospective analysis of adrenal function in patients with acute exacerbations of COPD: the Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) trial

Détails

ID Serval
serval:BIB_9E0A0F2D630A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Prospective analysis of adrenal function in patients with acute exacerbations of COPD: the Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) trial
Périodique
Eur J Endocrinol
Auteur⸱e⸱s
Schuetz P., Leuppi J. D., Bingisser R., Bodmer M., Briel M., Drescher T., Duerring U., Henzen C., Leibbrandt Y., Maier S., Miedinger D., Mueller B., Scherr A., Schindler C., Stoeckli R., Viatte S., von Garnier C., Tamm M., Rutishauser J.
ISSN
1479-683X (Electronic)
ISSN-L
0804-4643
Statut éditorial
Publié
Date de publication
07/2015
Volume
173
Numéro
1
Pages
19-27
Langue
anglais
Notes
Schuetz, Philipp
Leuppi, Jorg D
Bingisser, Roland
Bodmer, Michael
Briel, Matthias
Drescher, Tilman
Duerring, Ursula
Henzen, Christoph
Leibbrandt, Yolanda
Maier, Sabrina
Miedinger, David
Mueller, Beat
Scherr, Andreas
Schindler, Christian
Stoeckli, Rolf
Viatte, Sebastien
von Garnier, Christophe
Tamm, Michael
Rutishauser, Jonas
eng
Multicenter Study
Observational Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
England
Eur J Endocrinol. 2015 Jul;173(1):19-27. doi: 10.1530/EJE-15-0182. Epub 2015 Apr 8.
Résumé
OBJECTIVE: To analyze prospectively the hypothalamic-pituitary-adrenal (HPA) axis and clinical outcome in patients treated with prednisone for exacerbated chronic obstructive pulmonary disease (COPD). DESIGN: Prospective observational study. SUBJECTS AND METHODS: Patients presenting to the emergency department were randomized to receive 40 mg prednisone daily for 5 or 14 days in a placebo-controlled manner. The HPA axis was longitudinally assessed with the 1 mug corticotropin test and a clinical hypocortisolism score at baseline, on day 6 before blinded treatment, at hospital discharge, and for up to 180 days of follow-up. Prednisone was stopped abruptly, irrespective of the test results. Patients discharged with pathological test results received instructions about emergency hydrocortisone treatment. RESULTS: A total of 311 patients were included in the analysis. Mean basal and stimulated serum total cortisol levels were highest on admission (496+/-398 and 816+/-413 nmol/l respectively) and lowest on day 6 (235+/-174 and 453+/-178 nmol/l respectively). Pathological stimulation tests were found in 63, 38, 9, 3, and 2% of patients on day 6, at discharge, and on days 30, 90, and 180 respectively, without significant difference between treatment groups. Clinical indicators of hypocortisolism did not correlate with stimulation test results, but cortisol levels were inversely associated with re-exacerbation risk. There were no hospitalizations or deaths as a result of adrenal crisis. CONCLUSION: Dynamic changes in the HPA axis occur during and after the treatment of acute exacerbations of COPD. In hypocortisolemic patients who were provided with instructions about stress prophylaxis, the abrupt termination of prednisone appeared safe.
Mots-clé
Adrenal Cortex Function Tests, Adrenal Cortex Hormones/*adverse effects/*therapeutic use, Adrenal Glands/*physiopathology, Adrenal Insufficiency/physiopathology, Adrenocorticotropic Hormone, Aged, Female, Follow-Up Studies, Humans, Hydrocortisone/deficiency, Hypothalamo-Hypophyseal System/drug effects, Male, Middle Aged, Pituitary-Adrenal System/drug effects, Prednisone/adverse effects/therapeutic use, Prospective Studies, Pulmonary Disease, Chronic Obstructive/*drug therapy/*physiopathology, Treatment Outcome
Pubmed
Création de la notice
15/04/2021 9:58
Dernière modification de la notice
01/05/2021 5:33
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