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Pulmonary Disease, Chronic ObstructiveRECUTNCT02386735

Reduction of Corticosteroid Use in Outpatient Treatment of Exacerbated COPD

A study testing Prednisone in people with Pulmonary Disease, Chronic Obstructive and Adverse Effect of Glucocorticoids and Synthetic Analogues, run by Prof. Dr. Jörg Leuppi at 1 site in Switzerland.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Background Chronic obstructive pulmonary disease (COPD) is a major public health issue with no curative treatment. In Switzerland estimated 5-7% of the total population are suffering from this chronic disease. Read more about this study

Who is it for?
Ages 40 years and older
What is being tested?
Prednisone
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
133 participants
Where
1 siteSwitzerland
Study dates
Mar 2015to 31 Jul 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Informed Consent as documented by signature
  • Age ≥40 years
  • History of ≥10 pack-years of smoking (past or present smokers)
  • Airway obstruction, defined as FEV1/FVC≤70%
  • Current acute exacerbation of COPD by clinical criteria, defined by the presence of at least two of the following:
  • Change of baseline dyspnea
  • Change of cough
  • Change of sputum quantity or purulence

Who cannot join

  • Diagnosis of asthma
  • Initial necessity of hospitalization
  • Women who are pregnant or breast feeding
  • Premenopausal women with insufficient contraception and anamnestic risk for pregnancy
  • Severe coexisting disease with life expectancy <6 months
  • Diagnosis of tuberculosis
Show all 10Show fewer
  • Known severe immunosuppression or immunosuppression after solid organ or stem cell transplantation
  • Inability to follow study procedures, e.g. due to language problems, psychological disorders, dementia, etc. of the participant
  • Participation in another study involving an investigational drug
  • Previous enrolment into the current study

Trial locations and contacts

1 site in 1 country.

Switzerland1 site
  • Kantonsspital Baselland

    Liestal, Basel-Landschaft, 4410

Other trials in Switzerland

About this study

Official title: Reduction of Corticosteroid Use in Outpatient Treatment of Exacerbated COPD - a Randomized, Double-blind, Non-inferiority Study (The "RECUT"-Trial)

Background

Chronic obstructive pulmonary disease (COPD) is a major public health issue with no curative treatment. In Switzerland estimated 5-7% of the total population are suffering from this chronic disease. According to current guidelines corticosteroids are part of treatment of acute exacerbations in COPD patients. Several studies suggest that corticosteroids accelerate the recovery of forced expiratory volume in 1 second (FEV1), decrease duration of hospitalization, reduce treatment failure rate and improve clinical outcome. The additional therapeutic benefit on FEV1-recovery tough seems only to last for three to five days. The investigators recently published a hospital-based study showing that in patients presenting to emergency departments with acute exacerbation of COPD, a short five day treatment with systemic steroids was not inferior to a conventional 14 day treatment with regard to re-exacerbation. Cumulative corticosteroid dose could be reduced in this trial. To the investigators knowledge no data is available about the minimal necessary corticosteroid dose in an outpatient treatment setting so far.

Read more

Aim

The primary aim of this study is to investigate in an outpatient setting, whether a three day treatment with orally administered systemic corticosteroids is non-inferior to a five day treatment in acute exacerbation of COPD and if total glucocorticoid exposure can be reduced by shorter therapy.

Hypothesis

The investigators postulate, that in an outpatient setting, where generally less severe exacerbations are being treated, a three day treatment duration of systemic corticosteroids should be non-inferior to a five day treatment duration with regard to treatment benefits but decrease cumulative corticosteroid exposure.

Design and Setting

This study is going to be performed as a prospective, randomized, double-blind, placebo-controlled, non-inferiority trial in an outpatient setting. Randomization will be performed as block randomization with a 1:1 allocation. The investigators are going to recruit GPs in northwestern and central Switzerland.

Methods

The investigators are going to include patients presenting to GP's with acute exacerbation of COPD. When matching the investigators eligibility criteria and written informed consent is given, patients included in the study are receiving systemic corticosteroid treatment (equivalent of 40mg prednisone daily) for either five days (conventional arm) or three days (interventional arm) followed by two days of placebo for the interventional group. Pre-randomized, identically looking, numbered blisters are given to all patients included in the study. Antibiotic treatment (Amoxicillin/Clavulanic acid, 625mg 3/d, for ten days) is given to all patients with a CRP ≥50mg/l, COPD and known diagnosis of bronchiectasis, as well as patients presenting with all three of the following symptoms: change of baseline dyspnea, change of sputum quantity and sputum purulence. Further initial treatment and steroid treatment after inclusion is determined and documented by the GP. Patients will undergo follow-up visits at day three and seven by their GP as well as follow-up phone calls executed by the study center at day 30, 90 and 180.

Being tested
Placebo, Prednisone
Keywords
Corticosteroid treatment, COPD, Primary Health Care, Randomized controlled trial
Medical subject headings
Pulmonary Disease, Chronic Obstructive, Disease Progression

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PlaceboDrug

    Three days prednisone 40mg, two days placebo

  • PrednisoneDrug

    Five days prednisone 40mg.

Study groups in NCT02386735
Study groupRoleWhat they receive
Investigational treatmentExperimentalPatients included in the placebo group are receiving systemic corticosteroid treatment (equivalent of 40mg prednisone daily) for three days followed by two days of placebo.
Receives: Drug: Placebo
Standard treatmentActive comparatorPatients included in the control group are receiving systemic corticosteroid treatment (equivalent of 40mg prednisone daily) for five days as recommended in current guidelines.
Receives: Drug: Prednisone

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Time to next exacerbation

    Measured: Six month follow-up period after index exacerbation.

Secondary outcomes (5)
  1. Cumulative glucocorticoid dose

    Measured: Six month follow-up period after index exacerbation.

  2. Glucocorticoid side effects and complications

    Measured: Six month follow-up period after index exacerbation.

  3. Change in FEV1

    Measured: 7 days follow-up period after index exacerbation.

  4. Hospitalization rate during index exacerbation

    Measured: Six month follow-up period after index exacerbation.

  5. Overall mortality

    Measured: Six month follow-up period after index exacerbation.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Mar 2015 (estimated)
  2. Study startMar 2015
  3. Primary completion31 Jul 2024
  4. Study completion31 Jul 2024

Why it stopped: Low recruitment rate, motivation and engagement of participating GPs unfortunately declined over time, as well as the financial resources.

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
133 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02386735
Sponsor's protocol ID
KSBL2015-017
Acronym
RECUT
Status last verified
Mar 2025
First submitted
11 Feb 2015
Last updated
12 Mar 2025
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Leuppi JD, Miedinger D, Chhajed PN, Buess C, Schafroth S, Bucher HC, Tamm M. Quality of spirometry in primary care for case finding of airway obstruction in smokers. Respiration. 2010;79(6):469-74. doi: 10.1159/000243162. Epub 2009 Sep 26.

    PubMed 19786731
  • Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002 Oct;57(10):847-52. doi: 10.1136/thorax.57.10.847.

    PubMed 12324669
  • Makris D, Moschandreas J, Damianaki A, Ntaoukakis E, Siafakas NM, Milic Emili J, Tzanakis N. Exacerbations and lung function decline in COPD: new insights in current and ex-smokers. Respir Med. 2007 Jun;101(6):1305-12. doi: 10.1016/j.rmed.2006.10.012. Epub 2006 Nov 16.

    PubMed 17112715
  • Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med. 2000 Jul 27;343(4):269-80. doi: 10.1056/NEJM200007273430407. No abstract available.

    PubMed 10911010
  • Sapey E, Stockley RA. COPD exacerbations . 2: aetiology. Thorax. 2006 Mar;61(3):250-8. doi: 10.1136/thx.2005.041822.

    PubMed 16517585
  • Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. 2008 Nov 27;359(22):2355-65. doi: 10.1056/NEJMra0800353. No abstract available.

    PubMed 19038881
  • Mohan A, Chandra S, Agarwal D, Guleria R, Broor S, Gaur B, Pandey RM. Prevalence of viral infection detected by PCR and RT-PCR in patients with acute exacerbation of COPD: a systematic review. Respirology. 2010 Apr;15(3):536-42. doi: 10.1111/j.1440-1843.2010.01722.x.

    PubMed 20415983
  • Leuppi JD, Schuetz P, Bingisser R, Bodmer M, Briel M, Drescher T, Duerring U, Henzen C, Leibbrandt Y, Maier S, Miedinger D, Muller B, Scherr A, Schindler C, Stoeckli R, Viatte S, von Garnier C, Tamm M, Rutishauser J. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA. 2013 Jun 5;309(21):2223-31. doi: 10.1001/jama.2013.5023.

    PubMed 23695200
  • Albert RK, Martin TR, Lewis SW. Controlled clinical trial of methylprednisolone in patients with chronic bronchitis and acute respiratory insufficiency. Ann Intern Med. 1980 Jun;92(6):753-8. doi: 10.7326/0003-4819-92-6-753.

    PubMed 6770731
  • Emerman CL, Connors AF, Lukens TW, May ME, Effron D. A randomized controlled trial of methylprednisolone in the emergency treatment of acute exacerbations of COPD. Chest. 1989 Mar;95(3):563-7. doi: 10.1378/chest.95.3.563.

    PubMed 2920584
  • Bullard MJ, Liaw SJ, Tsai YH, Min HP. Early corticosteroid use in acute exacerbations of chronic airflow obstruction. Am J Emerg Med. 1996 Mar;14(2):139-43. doi: 10.1016/S0735-6757(96)90120-5.

    PubMed 8924134
  • Thompson WH, Nielson CP, Carvalho P, Charan NB, Crowley JJ. Controlled trial of oral prednisone in outpatients with acute COPD exacerbation. Am J Respir Crit Care Med. 1996 Aug;154(2 Pt 1):407-12. doi: 10.1164/ajrccm.154.2.8756814.

    PubMed 8756814
  • Aaron SD, Vandemheen KL, Hebert P, Dales R, Stiell IG, Ahuja J, Dickinson G, Brison R, Rowe BH, Dreyer J, Yetisir E, Cass D, Wells G. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N Engl J Med. 2003 Jun 26;348(26):2618-25. doi: 10.1056/NEJMoa023161.

    PubMed 12826636
  • Niewoehner DE, Erbland ML, Deupree RH, Collins D, Gross NJ, Light RW, Anderson P, Morgan NA. 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. doi: 10.1056/NEJM199906243402502.

    PubMed 10379017
  • Davies L, Angus RM, Calverley PM. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Lancet. 1999 Aug 7;354(9177):456-60. doi: 10.1016/s0140-6736(98)11326-0.

    PubMed 10465169

Questions about this trial

What is this clinical trial studying?

A study testing Prednisone in people with Pulmonary Disease, Chronic Obstructive and Adverse Effect of Glucocorticoids and Synthetic Analogues, run by Prof. Dr. Jörg Leuppi at 1 site in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 12 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study was stopped early (reason given: Low recruitment rate, motivation and engagement of participating GPs unfortunately declined over time, as well as the financial resources.). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time to next exacerbation (time frame: Six month follow-up period after index exacerbation.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02386735, which also lists 25 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Mar 2025.

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