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ICS withdrawal and exacerbation risk by GOLD 2017 Report: post hoc analysis of the WISDOM trial

Introduction: The 2017 GOLD* A–D grouping scheme is solely based on exacerbation history and symptoms, and no longer considers lung function. Aim: To examine the effect of ICS withdrawal in the WISDOM trial within the new GOLD 2017 groups A–D. Methods: In WISDOM, a 12-month, double-blind, parallel-group study, patients with COPD who had ≥1 exacerbation in the preceding 12 months and FEV1 Results: The proportion of the total population of patients experiencing exacerbations was lowest in the GOLD A group (35.8%) and highest in the GOLD D group (51.7%). There was no significant difference in exacerbations between ICS and ICS withdrawal in any group (Figure). Conclusion: The GOLD 2017 classification was a good predictor of exacerbation in WISDOM, with far fewer exacerbations in the GOLD A and B groups than in the C and D groups. Consistent with GOLD 2017 treatment recommendations and with the conclusions of the WISDOM trial, there was no significant increased risk of exacerbation with ICS withdrawal versus continuing ICS in any group. *Global Initiative for Chronic Obstructive Lung Disease 2017. Available from: http://goldcopd.org.