By Joanna Lyford, Senior medwireNews Reporter
A systematic review and meta-analysis confirms that testosterone therapy improves exercise capacity in men with chronic obstructive pulmonary disease (COPD).
The report, which appears in BMJ Open, found that testosterone levels were below-normal in COPD patients and that testosterone supplementation improved peak muscle strength and peak workload.
“We believe that our meta-analytic results are sufficiently reliable to recommend that clinicians should consider testosterone deficiency in these patients,” write Evan Atlantis (University of Western Sydney, New South Wales, Australia) and co-authors.
The team searched the literature and identified 15 studies that met their inclusion criteria. Nine were observational studies of endogenous testosterone levels in COPD patients and six were randomized controlled trials of testosterone therapy in patients with COPD.
Analysis of the nine observational studies, which included 2918 people, found that testosterone levels were significantly lower in men with COPD than in healthy controls. The pooled weighted mean difference (WMD) was –3.21 nmol/L.
Excluding studies of lower quality increased the pooled WMD to –3.68 nmol/L, while a study that provided unadjusted data decreased the WMD to –2.95 nmol/L.
The six randomized trials of testosterone supplementation therapy included 287 patients with COPD; participants were predominantly male and all but one study used placebo as control therapy.
Meta-analysis of these trials found that active therapy significantly improved standardized peak muscle strength (pooled standardized mean difference [SMD], 0.31) and peak workload (pooled SMD, 0.27). Testosterone therapy did not improve peak oxygen uptake or health-related quality of life outcomes, however.
Two of the trials also found that testosterone therapy was associated with an excess of serious adverse events, including COPD exacerbations and respiratory failure, compared with controls. Atlantis et al say that, while their results indicate that clinicians should consider testosterone deficiency in men with COPD, there is “insufficient evidence to draw firm conclusions about the long-term benefits and risks of testosterone therapies.”
They write: “Reliable information on the efficacy and safety, as well as cost-effectiveness, of specific testosterone therapies is required to inform clinical practice guidelines for COPD.”
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