Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease
SCCOPE trial design and results
Design
Randomised, double-blind, placebo-controlled trial across 25 Veterans Affairs centres
Treatment
An 8-week or a 2-week course of systemic glucocorticoids
Control
Placebo
Population
271 patients hospitalised for a COPD exacerbation, of 1840 screened; about half were ineligible because they had received systemic glucocorticoids in the previous 30 days
Follow-up
6 months
Primary endpoint
Treatment failure — death, intubation, readmission or intensification of therapy
Result
Treatment failure was higher with placebo than with the two glucocorticoid groups combined, at 30 days (33% versus 23%, p=0.04) and at 90 days (48% versus 37%, p=0.04). There was no difference between the 8-week and 2-week courses, and no mortality benefit. Hyperglycaemia severe enough to require treatment was the commonest complication.
Secondary endpoints
Length of stay, FEV1, mortality, hyperglycaemia
Treatment with systemic glucocorticoids results in moderate improvement in clinical outcomes among patients hospitalized for exacerbations of COPD. The maximal benefit is obtained during the first two weeks of therapy. Hyperglycemia of sufficient severity to warrant treatment is the most frequent complication.
The trial authors, in the published abstract
How it has aged
The trial behind giving steroids for a COPD exacerbation, and behind the short course: eight weeks was no better than two, which later work shortened further to five days. The word in the authors' own conclusion is 'moderate' — a 10 percentage point absolute reduction in treatment failure, no mortality benefit, and hyperglycaemia in return. Sits alongside Anthonisen 1987 as the other half of exacerbation management.
Publications
Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group
Niewoehner DE, Erbland ML, Deupree RH, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N Engl J Med 1999 Jun 24;340(25):1941-7.
Treatment failure 23% versus 33% at 30 days
No advantage of 8 weeks over 2 weeks of therapy
No mortality benefit; hyperglycaemia the commonest complication