TY - JOUR

T1 - Bone turnover biomarkers in COPD patients randomized to either a regular or shortened course of corticosteroids

T2 - A substudy of the randomized controlled CORTICO-COP trial

AU - Sivapalan, Pradeesh

AU - Jørgensen, Niklas R.

AU - Mathioudakis, Alexander G.

AU - Eklöf, Josefin

AU - Lapperre, Therese

AU - Ulrik, Charlotte Suppli

AU - Andreassen, Helle F.

AU - Armbruster, Karin

AU - Sivapalan, Praleene

AU - Janner, Julie

AU - Godtfredsen, Nina

AU - Weinreich, Ulla M.

AU - Nielsen, Thyge L.

AU - Seersholm, Niels

AU - Wilcke, Torgny

AU - Schuetz, Philipp

AU - Klausen, Tobias W.

AU - Marså, Kristoffer

AU - Vestbo, Jørgen

AU - Jensen, Jens Ulrik

PY - 2020

Y1 - 2020

N2 - Background: Long-term treatment with corticosteroids causes loss of bone density, but the effects of using short-term high-dose systemic-corticosteroid therapy to treat acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are unclear. Our aim was to determine whether high-dose corticosteroid therapy affected bone turnover markers (BTMs) to a greater extent compared to low-dose corticosteroid therapy. Methods: The CORTICO-COP trial (NCT02857842) showed that an eosinophil-guided corticosteroid intervention led to approximately 60% lower accumulated corticosteroid dose for hospitalized patients with AECOPD (low-dose group) compared with 5-day standard corticosteroid treatment (high-dose group). We compared the levels of BTMs C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP) in 318 participants during AECOPD and at 1- and 3-month follow-up visits. Results: CTX decreased and P1NP increased significantly over time in both treatment groups. There were no significant differences between the groups at 1- or 3-months follow-up for P1NP. A significant drop in CTX was seen at 3 months (down Δ24% from the baseline, p = 0.017) for the high dose group. Conclusion: Short-term, high-dose systemic corticosteroid treatment caused a rapid suppression of biomarkers of bone resorption. Corticosteroids did not suppress biomarkers of bone formation, regardless of patients receiving low or high doses of corticosteroids. This therapy was, therefore, harmless in terms of bone safety, in our prospective series of COPD patients. Trial registration: ClinicalTrials.gov Identifier: NCT02857842. Submitted August 2nd, 2016.

AB - Background: Long-term treatment with corticosteroids causes loss of bone density, but the effects of using short-term high-dose systemic-corticosteroid therapy to treat acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are unclear. Our aim was to determine whether high-dose corticosteroid therapy affected bone turnover markers (BTMs) to a greater extent compared to low-dose corticosteroid therapy. Methods: The CORTICO-COP trial (NCT02857842) showed that an eosinophil-guided corticosteroid intervention led to approximately 60% lower accumulated corticosteroid dose for hospitalized patients with AECOPD (low-dose group) compared with 5-day standard corticosteroid treatment (high-dose group). We compared the levels of BTMs C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP) in 318 participants during AECOPD and at 1- and 3-month follow-up visits. Results: CTX decreased and P1NP increased significantly over time in both treatment groups. There were no significant differences between the groups at 1- or 3-months follow-up for P1NP. A significant drop in CTX was seen at 3 months (down Δ24% from the baseline, p = 0.017) for the high dose group. Conclusion: Short-term, high-dose systemic corticosteroid treatment caused a rapid suppression of biomarkers of bone resorption. Corticosteroids did not suppress biomarkers of bone formation, regardless of patients receiving low or high doses of corticosteroids. This therapy was, therefore, harmless in terms of bone safety, in our prospective series of COPD patients. Trial registration: ClinicalTrials.gov Identifier: NCT02857842. Submitted August 2nd, 2016.

KW - Adverse effects

KW - Bone remodelling

KW - Bone turnover markers

KW - Chronic obstructive pulmonary disease

KW - Corticosteroids

U2 - 10.1186/s12931-020-01531-9

DO - 10.1186/s12931-020-01531-9

M3 - Journal article

C2 - 33046053

AN - SCOPUS:85092505951

VL - 21

JO - Respiratory Research (Print)

JF - Respiratory Research (Print)

SN - 1465-9921

M1 - 263

ER -