Prednisone Superior to Other Corticosteroids for Patients With COPD, Heart Failure

This article was originally published on Drug Topics^® and has been lightly edited.

Patients with a dual diagnosis of chronic obstructive pulmonary disease (COPD) and heart failure who take prednisone have shorter hospital stays compared to patients given other corticosteroids, according to research data presented at the CHEST 2024 annual meeting, held October 6 to 9 in Boston, Massachusetts.¹

According to data from the CDC, there were over 790,000 visits to the emergency department due to COPD in 2021.² Each year, COPD medical costs for patients 45 years of age and older equal around $24 billion, with $11.9 billion being due to medications and $900 million due to emergency room costs. From 2000 to 2018, the average yearly COPD medical costs increased by over 70%.³

Heart failure has a similar burden as COPD, and the 2 conditions often coexist. COPD and heart failure share many risk factors and heart failure often goes undiagnosed in patients with COPD. Research has found that between 17% and 20.5% of stable COPD patients had undiagnosed left-sided heart failure.4

Research presented at CHEST 2024 examined the effect of steroid choice on individuals who have a dual diagnosis of heart failure and chronic obstructive pulmonary disease (COPD). | Image Credit: luchschenF - stock.adobe.com

Investigators conducted a study to assess the effect of steroid choice on individuals who have a dual diagnosis of heart failure and COPD. Data for the study was gathered from a divisional database consisting of 16,129 patients who were diagnosed with COPD exacerbation and heart failure and were also taking a corticosteroid. Patients were excluded if they did not have an active diagnosis of heart failure or had inadequate medication reconciliation.

The final study analysis included 6153 patients who were admitted to an HCA Healthcare facility between January 2016 and June 2023.

Investigators found that patients on prednisone stayed in the hospital for an average of 7.33 days, compared to 9.83 days for patients on dexamethasone. The study also showed that 6.72% of patients who received prednisone died during their initial encounter, compared to 20.34% of patients on methylprednisolone.

The authors of the study said that the findings will structure how they treat patients with a dual diagnosis of heart failure and COPD exacerbation. They added that further research is needed to determine the exact response of why prednisone shows superior outcomes in this population of patients with a broad diagnosis of COPD exacerbation and heart failure.

“Prednisone is the most effective oral steroid for patients with heart failure and COPD exacerbation,” the authors concluded. “Steroids with less mineralocorticoid activity, such as dexamethasone, do not affect health outcomes. Glucocorticoid and mineralocorticoid activity may have different outcomes, indicating minimal effect on measured outcomes among patients with heart failure. Despite the weak body of evidence, current guidelines still recommend the administration of systemic steroids.”

References

1. Denney M, Reid M, Tan H, et al. Variation in outcome based on corticosteroid amongst patients with a dual diagnosis of COPD exacerbation and heart failure. Presented at: American College of Chest Physicians 2024 Annual Meeting; October 6-9, 2024; Boston, MA. Poster 4239.

2. Chronic obstructive pulmonary disease (COPD) includes: chronic bronchitis and emphysema. Report. CDC. April 30, 2024. Accessed October 8, 2024. https://www.cdc.gov/nchs/fastats/copd.htm

3. COPD Trends Brief: Burden. Report. American Lung Association. Accessed October 8, 2024. https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief/copd-burden

4. Hesse K, Bourke S, Steer J. Heart failure in patients with COPD exacerbations: Looking below the tip of the iceberg. Respir Med. 2022 May;196:106800. doi:10.1016/j.rmed.2022.106800.