RCT: Bisoprolol Does Not Reduce COPD Exacerbations in High-Risk Patients – JAMA

Study Design and Population: The Bisoprolol in COPD Study (BICS) was a double-blind, placebo-controlled randomized clinical trial conducted across 76 sites in the UK, including both primary and secondary care clinics. The study enrolled 515 patients with chronic obstructive pulmonary disease (COPD) who had moderate to severe airflow obstruction and a history of at least two exacerbations in the past year. Participants were randomly assigned to receive either bisoprolol (n=261) or placebo (n=258) and were followed for one year.

Main Findings: The primary outcome, the number of COPD exacerbations requiring treatment with oral corticosteroids, antibiotics, or both, did not differ significantly between the bisoprolol group (mean exacerbations, 2.03 per year) and the placebo group (mean exacerbations, 2.01 per year). The adjusted incidence rate ratio was 0.97 (95% CI, 0.84-1.13; P = .72), indicating no significant reduction in exacerbations with bisoprolol. Additionally, the rates of serious adverse events were similar between the two groups.

Implications for Practice: The findings suggest that bisoprolol does not reduce exacerbations in COPD patients at high risk and should not be recommended for this purpose. This study underscores the need for continued research into effective interventions for preventing COPD exacerbations in high-risk populations.

Reference: Devereux, G. et al. (2024). Bisoprolol in Patients With Chronic Obstructive Pulmonary Disease at High Risk of Exacerbation: The BICS Randomized Clinical Trial. JAMA, 332(6), 462-470. DOI: 10.1001/jama.2024.8771.