Background: Corticosteroid treatment for acute exacerbations of COPD (AECOPD) reduces the length of hospital stay. Corticosteroid-sparing regimens have showed non-inferiority to higher accumulated dose regimens regarding re-exacerbation risk in patients with AECOPD. However, it remains unknown, if higher accumulated dose regimens as compared to low-medium accumulated dose regimens, leads to shorter admissions and changes in mortality risk. We explored this by analysing the number of days alive and out of hospital (DAOH).

Methods: We pooled individual patient data from the two available multicentre RCTs on corticosteroid-sparing regimens for AECOPD: REDUCE (n=314) and CORTICO-COP trial (n=318). Patients randomly allocated to 14 days regimen were compared to 2–5 days regimens, adjusting for confounders.

Results: DAOH within 14 days from recruitment was higher for the low–medium (mean 8.3 days;(95%CI) 7.9–8.7) than the high accumulated regimen group (4.2 days; 3.6–4.9;p <.001). High accumulated regime AECOPD group had longer hospital stays, decreased likelihood of discharge within 30 days (HR, 0.6 [0.5–0.7];p<.0001), no differences in the composite endpoint ‘death or ICU admission’ (OR, 1.4 [0.9–2.3];p =.25), new or aggravated hypertension (OR, 1.5 [0.9–2.7]; p=0.15), or mortality risk (HR, 0.8 [0.4–1.5];p= .45) during the 6-month follow-up.

Conclusion: Higher corticosteroid dose regimens were associated with longer hospital stays and fewer DAOH within 14 days, with no apparent 6-month benefit regarding death or admission to ICU in COPD patients