Adding low dose theophylline to inhaled corticosteroids does not reduce COPD exacerbations

Adding low dose theophylline to inhaled corticosteroids does not reduce COPD exacerbations

A CRN supported Respiratory Disorders trial (TWICS), which investigated whether taking a low-dose theophylline tablets in addition to inhaled corticosteroids would reduce chronic obstructive pulmonary disease flare-ups was recently published by NIHR Dissemination Centre as one of its Signals.

NIHR Signals are accessible, actionable summaries of recent, important health research. Through Signals, the NIHR Dissemination Centre aims to put good research evidence at the heart of decision making in the NHS, public health and social care. The TWICS trial was published as an NIHR Signal as a result of it’s high quality trial design and relevance to UK decision makers.

Professor David Price, Chief Investigator for the TWICS trial says:

“We are delighted that the TWICS trial was chosen as an NIHR Signal. Theophylline tablets can aid breathing but may have unpleasant side effects at the doses usually used in the past. Some small studies have suggested that lower doses of theophylline can increase the anti-inflammatory effect of inhaled corticosteroids and might thereby reduce the risk of flare-ups. This larger scale study helped to address this uncertainty.”

The trial which took place from 2014-2017, demonstrated that taking a low-dose theophylline tablets in addition to inhaled corticosteroids did not significantly reduce chronic obstructive pulmonary disease flare-ups. This NIHR funded study found that people taking the combination and those taking an inhaled corticosteroid had the same number of exacerbations – just over two per year.

People who experience frequent exacerbations are often prescribed corticosteroid inhalers to reduce inflammation of the airways. Theophylline also helps open up the airways, but the doses needed to be effective can produce unwanted side effects.

Some earlier evidence suggested that low-dose theophylline might improve the anti-inflammatory effects of inhaled corticosteroids and therefore could be useful for those who continue to suffer exacerbations and hospital admissions.

However, the results of this study confirm guideline recommendations that, for the majority of people, the combination of oral theophylline plus inhaled corticosteroid is not useful.

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This news release is also published on the CRN Intranet website, authored by Sarah Wharton.