Grade table 13, [Question: Should short course of...]. - Prevention and Control of Noncommunicable Diseases

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Grade table 13

Question: Should short course of oral corticosteroids (<3 wks) versus placebo be used in patients with COPD?

Settings: LMICs

Bibliography: Walters JAE et al. (14)

Quality assessment							Summary of findings					Importance
Quality assessment							No of patients		Effects		Quality
No of studies	Design	Limitations	Inconsistency	Indirectness	Imprecision	Other considerations	Short course of oral corticosteroids (<3 wks)	Placebo	Relative (95% CI)	Absolute	Quality
Mortality (assessed with: number of patients died)
0	no evidence available					none	–	–	–	–	–	–
0	no evidence available					none	-	0%	–	-	–	–
QoL measured by CRQ (follow-up mean 14 days; measured with: scores; better indicated by higher values)
1¹	randomised trials	serious²	no serious inconsistency	serious³	no serious imprecision	reporting bias⁴	67	67²	–	MD 0.32 higher (0.17 to 0.47 higher)	⊕○○○ VERY LOW	IMPORTANT
Breathlessness (follow-up 14–21 days; measured with: different scale scores were used in different studies; better indicated by lower values)
3	randomised trials²	serious²^,⁵	serious⁶	serious³	no serious imprecision	reporting bias⁴	217	217²	–	not pooled	⊕○○○ VERY LOW	IMPORTANT
Cough (follow-up mean 21 days⁷; measured with: symptom scores on a scale of 0 (best) to 6 (worst); range of scores: 0–6; better indicated by lower values)
1	randomised trials²	serious²	no serious inconsistency	serious³	no serious imprecision	reporting bias⁴	23	23²	–	MD 0.30 lower (0.82 lower to 0.22 higher)	⊕○○○ VERY LOW	–
Wheeze (follow-up mean 21 days²; measured with: symptom scale scores 0 (best) to 6 (worst); better indicated by lower values)
1	randomised trials²	serious²	no serious inconsistency	serious³	no serious imprecision	reporting bias⁴	23	23²	–	MD 0.30 lower (1.21 lower to 0.61 higher)	⊕○○○ VERY LOW	IMPORTANT
Sputum symptoms scores (follow-up mean 21 days⁷; measured with: sputum symptom scores 0 (best) to 6 (worst); range of scores: 0–6; better indicated by lower values)
1	randomised trials²	serious²	no serious inconsistency	serious³	no serious imprecision	reporting bias³	23	23²	–	MD 0.20 lower (0.75 lower to 0.35 higher)	⊕○○○ VERY LOW	IMPORTANT
Exacerbation (follow-up 14–21 days; assessed with: withdrawal from the study due to exacerbation)
3	randomised trials²	serious²	serious²	serious³	serious⁸	reporting bias³	–⁹	–	OR 0.44 (0.17 to 1.18)	–	⊕○○○ VERY LOW	IMPORTANT¹
3	randomised trials²	serious²	serious²	serious³	serious⁸	reporting bias³	-	0%	OR 0.44 (0.17 to 1.18)	-	⊕○○○ VERY LOW	IMPORTANT¹
Walking distance (follow-up mean 14 days; measured with: SMD using distance traveled in 12-minute walk test; better indicated by higher values)
3	randomised trials²	serious²^,¹⁰	serious²	serious³	serious⁸	reporting bias⁴	94	94²^,¹¹	–	SMD 0.44 higher (0.14 to 0.74 higher)	⊕○○○ VERY LOW	–
Adverse events (follow-up 14–28 days¹²; assessed with: number of patients with one or more adverse event)
3	randomised trials²	serious²^,⁶	serious²^,⁶	serious³	–	reporting bias⁴	–	–	OR 7.76 (2.34 to 25.70)¹³	–	–	CRITICAL
3	randomised trials²	serious²^,⁶	serious²^,⁶	serious³	–	reporting bias⁴	–	0%	OR 7.76 (2.34 to 25.70)¹³	–	–	CRITICAL
FEV1 (measured with: ml; better indicated by higher values)
14	randomised trials²	serious²^,⁶	serious⁶	serious³	no serious imprecision	reporting bias⁴	365	322	–	MD 53.30 higher (22.21 to 84.39 higher)	⊕○○○ VERY LOW	IMPORTANT
FVC
0	no evidence available					none	–	–	–	–	–	–
0	no evidence available					none	–	0%	–	–	–	–

1: Out of three studies only one study reported overall scores.
2: Cross-over design, difference in washout period and/or duration of treatment, carryover effect may impact the overall results.
3: Patient population is not from LMICs.
4: Literature search up to 4 May 2005.
5: Scored moderate to high on the Jadad scale.
6: Difference in baseline characteristics of patients, and/or duration and/or dose.
7: Treatment period. Follow-up duration is not reported.
8: Sample size is small and events rate is low.
9: Not reported in the review.
10: Scored moderate to low on the Jadad scale.
11: Numbers were double-counted in the tables due to cross-over design.
12: One study is more than three weeks duration.
13: Log odds ratios (ORs) pooled from the studies. Numbers from control and treatment groups not reported.

From: Annex 4, Grade tables

Cover of Prevention and Control of Noncommunicable Diseases

Prevention and Control of Noncommunicable Diseases: Guidelines for Primary Health Care in Low Resource Settings.

Geneva: World Health Organization; 2012.

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