Blood eosinophils and treatment response with triple and dual combination therapy in chronic obstructive pulmonary disease: analysis of the IMPACT trial

Pascoe, Steven; Barnes, Neil; Brusselle, Guy; Compton, Chris; Criner, Gerard J.; Dransfield, Mark T.; Halpin, David; Han, Mei Lan K.; Hartley, Benjamin; Lange, Peter; Lettis, Sally; Lipson, David A.; Lomas, David A.; Martínez, Fernando J.; Papi, Alberto; Roche, Nicolás; Valk, Ralf J.P. van der; Wise, Robert A.; Singh, Dave

doi:10.1016/s2213-2600(19)30190-0

Cited by 188 publications

(191 citation statements)

References 32 publications

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“…The majority (99.4%) were ineligible either because of a nonrigorous study methodology or lack of relevance to the PICO question, and this resulted in screeners identifying eight studies for final review inclusion. All eight identified unique studies were RCTs (29,31,(35)(36)(37)(38)(39)(40). The total sample size for the eight RCTs was 9,123 participants; 5,945 (65.2%) of these participants were in the treatment/intervention arms and 3,178 (34.8%) were in the control (comparator) arms.…”

Section: American Thoracic Society Documentsmentioning

confidence: 99%

See 1 more Smart Citation

Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline

Nici

Mammen

Charbek

et al. 2020

Am J Respir Crit Care Med

242

245

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Background: This document provides clinical recommendations for the pharmacologic treatment of chronic obstructive pulmonary disease (COPD). It represents a collaborative effort on the part of a panel of expert COPD clinicians and researchers along with a team of methodologists under the guidance of the American Thoracic Society. Methods: Comprehensive evidence syntheses were performed on all relevant studies that addressed the clinical questions and critical patient-centered outcomes agreed upon by the panel of experts. The evidence was appraised, rated, and graded, and recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Conclusions: The task force made recommendations regarding the pharmacologic treatment of COPD based on currently available evidence. Additional research in populations that are underrepresented in clinical trials is needed, including studies in patients with COPD 80 years of age and older, those with multiple chronic health conditions, and those with a codiagnosis of COPD and asthma.

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Section: American Thoracic Society Documentsmentioning

confidence: 99%

“…Pneumonia (>150 eosinophils). Two studies (n = 4,267) assessed incidence of pneumonia in patients with >150 blood eosinophils/ml (36,38). The studies revealed an increased risk of pneumonia with an ICS in addition to a long-acting bronchodilator (RR, 1.55; 95% CI, 1.23-1.95; P , 0.001).…”

Section: American Thoracic Society Documentsmentioning

confidence: 99%

Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline

Nici

Mammen

Charbek

et al. 2020

Am J Respir Crit Care Med

242

245

View full text Add to dashboard Cite

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“…Stratification of smokers broadly fell into two categories: current smoker versus ex-smoker in four studies 19 21-23 or heavier smoker versus lighter smoker in the remaining studies. 18 20 24 The study drugs used were either budesonide or fluticasone (propionate/furoate); five studies used fluticasone in combination with a long-actingbeta agonist (LABA), either salmeterol 18 22 23 or vilanterol, [19][20][21] and the remaining two used fluticasone 18 or budesonide alone. 24 The outcomes reported were either change in lung function (measured by FEV 1 ) in four studies, 18 21 22 24 or yearly exacerbation rates in four studies 19-21 23 (one study reported both).…”

Section: Resultsmentioning

confidence: 99%

“…Three trials, Wedzicha (2016), Hinds (2015) and Pascoe (2019), evaluated the rate ratio of yearly COPD exacerbations at 52 weeks in comparison to the alternative treatment arm and one, Bhatt (2018), the percentage change in exacerbations, as indicated in (table 3). 19-21 23 Hinds et al was a post hoc cluster analysis of the Effect of…”

Section: Effect On Exacerbation Ratementioning

confidence: 99%

Impact of smoking status on the efficacy of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review

2020

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Objectives Inhaled corticosteroids (ICS) reduce exacerbation rates and the decline in lung function in people with chronic obstructive pulmonary disease (COPD). There is evidence that smoking causes 'steroid resistance' and thus reduces the effect of ICS. This systematic review aimed to investigate the effect of smoking on efficacy of ICS in COPD in terms of lung function and exacerbation rates. Design Systematic review. Eligibility criteria Fully published randomised controlled trials (RCTs), in the English language, evaluating the use of ICS in COPD adults that stratified the participants by smoking status. Trials that included participants with asthma, lung cancer and pneumonia were excluded. The primary outcome measures were changes in lung function and yearly exacerbation rates. Data extraction and synthesis Two independent reviewers extracted data and assessed risk of bias using the Cochrane Collaboration's tool. results Seven studies were identified. Four trials (17 892 participants) recorded change in forced expiratory volume in one second (FEV 1 ) from baseline to up to 30 months after starting treatment. Heavier smokers (>36 pack years) using ICS had a greater decline in FEV 1 that ranged from −22 mL to −75 mL in comparison to lighter smokers. Smokers using ICS had mixed results in FEV 1 change: −8 mL to +77 mL in comparison to ex-smokers. Four trials (21 270 participants) recorded difference in COPD exacerbation rates at 52 weeks. The rate ratios favoured more exacerbations in ICS users who were current or heavier smokers than those who were ex-smokers or lighter smokers (0.81 to 0.99 vs 0.92 to 1.29). Conclusions In COPD, heavier or current smokers do not gain the same benefit from ICS use on lung function and exacerbation rates as lighter or ex-smokers do, however effects may not be clinically important. PrOsPErO registration number CRD42019121833

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“…Post-hoc analyses of RCTs comparing inhaled corticosteroids (ICS)/long-acting β 2 -agonist (LABA) therapy vs. LABA monotherapy for COPD patients with a history of exacerbations have explored the potential for baseline BEC to predict ICS response. These studies demonstrated that ICS effect on exacerbation prevention was larger for patients with higher baseline BEC ( ICS benefits apparent at approximately ≥100 cells/µL and greater effects at higher BEC ( Figure 2) (40). BEC also predicted treatment effects on lung function and health-related quality of life, although these results were less consistent.…”

Section: Inhaled Corticosteroidsmentioning

confidence: 98%

Blood Eosinophil Counts in Clinical Trials for Chronic Obstructive Pulmonary Disease

Singh

Bafadhel

Brightling

et al. 2020

Am J Respir Crit Care Med

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Blood eosinophils and treatment response with triple and dual combination therapy in chronic obstructive pulmonary disease: analysis of the IMPACT trial

Cited by 188 publications

References 32 publications

Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline

Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline

Impact of smoking status on the efficacy of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review

Blood Eosinophil Counts in Clinical Trials for Chronic Obstructive Pulmonary Disease

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