Blood Eosinophils and Response to Maintenance Chronic Obstructive Pulmonary Disease Treatment. Data from the FLAME Trial

Roche, N.; Chapman, Kenneth R.; Vogelmeier, Claus; Herth, Felix J.F.; Thach, Chau; Fogel, Robert; Olsson, Petter; Patalano, Francesco; Banerji, Donald; Wedzicha, Jadwiga A.

doi:10.1164/rccm.201701-0193oc

Cited by 153 publications

(144 citation statements)

References 40 publications

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“…More than one‐third (39.1%) of our patients have a BEC greater than 200, which is lower than the 49.4% mentioned by Hastie et al, as well as the 63.7% of the patients by Disantoestefano . Using the 300 cells/µL cut‐off point, 22.1% are equal or greater, similar to that referred to by Watz or Roche, but lower than other populations where these values increase between 32.5% and 41.4% . The results are more similar with a cut‐off point of 400 cells/µL, as 11.2% of our patients equal or exceed this figure, similar to the 11% mentioned by Watz et al, or to the 14.4% in the study by Disantoestefano …”

Section: Discussionsupporting

confidence: 74%

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Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations

Barcala

San-Jose²,

Nieto‐Fontarigo

et al. 2019

Int J Clin Pract

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Summary IntroductionThe aim of analysing the usefulness of the blood eosinophil count (BEC) as a prognostic marker in exacerbations of patients with Chronic Obstructive Pulmonary Disease (COPD), evaluating its relationship with hospital mortality, the length of stay and the early and late re‐admissions. Materials and MethodsWe have carried out a retrospective study including all patients who required hospital admission from 1 January 2008 to 31 December 2009, with a diagnosis on hospital discharge of COPD exacerbation. These patients were classified using three cut‐off points of BEC: less than 200 vs ≥ 200/µL, less than 300 vs ≥ 300/µL and less than 400 vs ≥ 400/µL. ResultsThere were a total of 1626 hospital admissions during the study period with the diagnosis of exacerbation of COPD. In this study we have included 358 patients. The probability of any late re‐admission increased with a BEC ≥ 300/µL (odds ratio: 1.684) and for those with a BEC ≥ 400/µL (odds ratio: 2.068). The BEC does not appear to be related to hospital mortality or the probability of early re‐admission after an exacerbation of COPD. ConclusionsIn our study an elevated BEC is associated with a higher incidence of late hospital readmissions in COPD exacerbations.

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Section: Discussionsupporting

confidence: 74%

“…The criteria to define eosinophilia vary widely. In our case we have chosen cut‐off points for the BEC of 200, 300 or 400/µL, which are of habitual use in the literature and help to establish comparisons with other studies . But other authors use different cut‐off points.…”

Section: Discussionmentioning

confidence: 99%

Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations

Barcala

San-Jose²,

Nieto‐Fontarigo

et al. 2019

Int J Clin Pract

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“…Most of the studies [155][156][157] except one 158 have demonstrated that high blood eosinophils could be valuable to predict an increase response in terms of reduction of exacerbation rate when treated with combination ICS/LABA. However, all these studies were secondary analyses or post hoc subgroup analyses.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…For example, it has been suggested that blood eosinophils could be useful clinically to predict COPD phenotype more likely to respond to ICS. [155][156][157][158][159] Another example is the bacterial colonization in some COPD patients that could contribute to the biological mechanisms of recurrent acute exacerbations. Under these circumstances, macrolides may reduce the risk for AECOPD although patients should be selected carefully considering the risk of bacterial resistance and side effects.…”

Section: Box 2 Preventing Acute Exacerbation In Stable Copdmentioning

confidence: 99%

CTS position statement: Pharmacotherapy in patients with COPD—An update

Bourbeau

Bhutani

Hernández

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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RATIONALE: Since the last published Canadian Thoracic Society (CTS) COPD guideline in 2007 and the 2008 update -highlights for primary care, many new clinical trials have challenged COPD treatment practices. The current Canadian position statement provides the reader with an update on pharmacotherapy of patients with COPD as reviewed by the CTS. OBJECTIVES: The objectives of this position statement are: 1) to summarize the literature on topics relevant to the pharmacological therapy of patients with stable COPD; and 2) to provide clinical guidance with evidence-based recommendations and expert-informed key messages for the pharmacological therapy for patients with stable COPD. METHODS: The authors systematically reviewed the relevant literature focusing on randomized controlled trials and when available, systematic reviews of randomized controlled trials. The proposed key messages, based on scientific evidence and expert-informed opinion, were agreed upon by a majority consensus. MAIN RESULTS: There is typically a significant delay in seeking medical care by patients with dyspnea, often waiting until symptoms affect the performance of activities of daily living. The diagnosis of COPD requires spirometry to confirm the presence of airflow obstruction in any patient presenting with symptoms and/or risk factors of COPD. An effective management plan for individuals with COPD should include: smoking cessation, vaccination and education. A number of non-pharmacological treatments are available for COPD patients with symptoms to improve outcomes such as self-management with coaching from a health care professional; pulmonary rehabilitation; supplemental oxygen in selected patients; and surgery.Current pharmacotherapy for COPD has been shown to alleviate symptoms and prevent exacerbations and related complications such as hospital admissions. In symptomatic patients with stable COPD not having or having infrequent exacerbation, treatment should be started with inhaled LAMA or LABA monotherapy, and if experiencing persistent or increased dyspnea, exercise intolerance, and/or reduced health status despite use of monotherapy, patients should be considered for treatment "step up" with an inhaled LAMA plus LABA dual therapy. In this situation, the use of a single inhaler would be preferred to simplify the treatment regimen and minimize the cost. In patients with stable COPD experiencing exacerbations despite the use of LAMA or LABA monotherapy, treatment "step up" with inhaled LAMA plus LABA dual therapy should be considered unless a patient has concomitant asthma (Asthma/COPD overlap (ACO)). There has been recent interest in using biomarkers to identify patients who are more likely to respond to ICS. Most of the studies have demonstrated that high blood eosinophils could be valuable to predict an increase response in terms of reduction of exacerbation rate when treated with combination ICS/LABA; there is still uncertainty about the exact cut-off level of blood eosinophils having potential therapeutic value. If a pa...

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“…Importantly, across all doses of ICS, fluticasone furoate and vilanterol reduced exacerbations by 29% compared with vilanterol alone in patients with eosinophil counts ≥2%, and by 10% in patients with eosinophil counts <2%. Analysis of data from the FLAME trial showed no significant reduction in exacerbation in indacaterol/gycopyrronium compared to salmeterol/fluticasone among patients with blood eosinophil levels of 150 to 300 cells/μL versus 300 cells/μL . In this study, we use the word “eosinophilia” to mean an elevated blood eosinophil count based on our defined cutoffs.…”

Section: Introductionmentioning

confidence: 99%

Blood eosinophilia, use of inhaled corticosteroids, and risk of COPD exacerbations and mortality

Oshagbemi

Franssen

Braeken

et al. 2018

Pharmacoepidemiology and Drug

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PurposeIt remains unclear whether eosinophilia is useful for in guiding inhaled corticosteroid (ICS) therapy in chronic obstructive pulmonary disease (COPD) patients. The goal of this study is to evaluate the risk of acute exacerbations, COPD‐related hospitalisations/accident and emergency visits, and all‐cause mortality with various levels of eosinophil counts among COPD patients using ICS.MethodsA cohort study was conducted using the UK Clinical Practice Research Datalink. Patients were aged 40+ and had COPD (n = 32 693). Current users of ICS were stratified by relative and absolute eosinophil counts to determine the risk of outcomes with blood eosiniphilia using Cox regression analysis.ResultsAmong COPD patients, current use of ICS was not associated with a reduced risk of acute COPD exacerbations, COPD‐related hospitalisations/accident and emergency visits, and all‐cause mortality. Stratification of ICS use by absolute or relative eosinophil counts did not result in significant differences in risk of COPD exacerbations or hospitalisations/accident and emergency visits. However, all‐cause mortality was reduced by 12% to 24% among patients with eosinophilia.ConclusionsCOPD‐related acute exacerbations or hospitalisations/accident and emergency visits were not reduced with eosinophilia among users of ICS with COPD. However, all‐cause mortality was reduced by 12% to 24%. These findings are potentially important and require further evaluation in prospective studies.

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Blood Eosinophils and Response to Maintenance Chronic Obstructive Pulmonary Disease Treatment. Data from the FLAME Trial

Abstract: Our prospective analyses indicate that indacaterol/glycopyrronium provides superior or similar benefits over salmeterol/fluticasone regardless of blood eosinophil levels in patients with COPD. Clinical trial registered with www.clinicaltrials.gov (NCT01782326).

Cited by 153 publications

References 40 publications

Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations

Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations

CTS position statement: Pharmacotherapy in patients with COPD—An update

Blood eosinophilia, use of inhaled corticosteroids, and risk of COPD exacerbations and mortality

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