Personalized Variable vs Fixed-Dose Systemic Corticosteroid Therapy in Hospitalized Patients With Acute Exacerbations of COPD

Li, Li; Zhao, Nan; Ma, Xiangyu; Sun, Fenfen; He, Binfeng; Qin, Zhen; Wu, Kui; Xingsheng, Wang; Zhao, Qiping; Zhang, Shisi; Nie, Naifu; Luo, Dong; Sun, Bin; Shen, Ye; He, Yong; Wen, Fuqiang; Zheng, Jinping; Jones, Paul; Cao, Guoqiang

doi:10.1016/j.chest.2021.05.024

Cited by 18 publications

(12 citation statements)

References 16 publications

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“… 15 Li et al performed a randomized multicenter prospective study of 228 COPD patients with severe acute exacerbations and similar blood eosinophil counts and showed that individualized systemic corticosteroid strategy for 5 days with larger daily dose of corticosteroids (greater than 60 mg of prednisone) was more effective than a fixed-dose of 40 mg/day of prednisone for 5 days. 16 Our results showed that the treatment response with 40 mg/day of methylprednisolone for ≤5 days was comparable with the response with 40 mg/day of methylprednisolone for ≥5 days. Furthermore, we observed significant statistical differences in the blood eosinophil counts between patients that responded to treatment with 40 mg/day of methylprednisolone within 5 days and patients that required longer treatment time.…”

Section: Discussionsupporting

confidence: 60%

Relationship Between Blood Eosinophils and Systemic Corticosteroid Therapy in COPD Exacerbation

Gong¹,

Sun²

2022

IJGM

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Purpose To assess the relationship between the duration of systemic corticosteroid therapy and blood eosinophil counts in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). Patients and Methods This study included 292 patients with acute COPD exacerbations treated with daily intravenous injections of 40 mg/day methylprednisolone at the Department of Respiratory Medicine, Anhui No.2 Provincial People’s Hospital, Hefei, China. The study subjects were divided into two groups – (1) a low-dose group (n = 136) that included patients treated with methylprednisolone for less than or equal to 5 days and (2) a high-dose group (n = 156) that included patients treated with methylprednisolone for more than 5 days. The blood eosinophil counts were analyzed for both the patient groups, and an optimal cut-off value was calculated to distinguish between the two groups. The study endpoints were readmission or deaths within 30 days or 180 days and re-infections within 90 days after hospital discharge. Results The mean blood eosinophil counts in the low- and high-dose groups were 0.15 × 10 9 /L (0.11–0.23 × 10 9 /L) and 0.08 × 10 9 /L (0.04–0.12 × 10 9 /L), respectively ( P < 0.01). Receiver operating characteristic (ROC) curve analysis showed that the cut-off value for the blood eosinophils to distinguish the two patient groups was 0.115 × 10 9 /L with a sensitivity and specificity of 72.8% and 72.4%, respectively. The number of readmissions between the two groups at 30 days and 180 days after hospital discharge did not show any significant differences ( P = 0.292, P = 0.398). The follow-up data showed significantly higher rate of re-infections in the high-dose group (24/136) within 90 days after hospital discharge compared to the low-dose group (9/156) ( P = 0.018). Conclusion In patients with acute exacerbations of COPD, blood eosinophil counts of ≥0.115 × 10 9 /L were associated with effective response to corticosteroid therapy in ≤5 days.

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Section: Discussionsupporting

confidence: 60%

Relationship Between Blood Eosinophils and Systemic Corticosteroid Therapy in COPD Exacerbation

Gong¹,

Sun²

2022

IJGM

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“…Recently, level of blood eosinophils has emerged as a potential biomarker in patients with COPD, based on the observation that levels of blood eosinophils appear to be associated with subsequent risk for exacerbation and to predict the response to corticosteroids treatment in clinical trials 10 11 25. In some previous studies of patients with COPD, a cut-off value of 2% for blood eosinophils has been widely used to predict COPD exacerbations 13 26. We used the threshold of 2% and found that >44% of patients with higher eosinophils in AECOPD were hospitalised.…”

Section: Discussionmentioning

confidence: 99%

Association of blood eosinophils with corticosteroid treatment failure stratified by smoking status among inpatients with AECOPD

Li,

Zuo,

Feng

et al. 2024

BMJ Open Resp Res

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BackgroundRecent studies have suggested elevated blood eosinophils are independent predictors of response to corticosteroid therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Smoking status has been shown to affect corticosteroid response. Whether the association between high blood eosinophils and corticosteroid treatment failure is modified by smoking has not been fully investigated so far.ObjectivesThis study aimed to assess whether the association between high blood eosinophils and corticosteroid treatment failure is modified by smoking.MethodsWe included 3402 inpatients with AECOPD treated with corticosteroids at Beijing Chao-Yang Hospital from July 2013 to June 2021. Blood eosinophil counts were measured within 24 hours of admission. An eosinophil percentage ≥2% was considered as high eosinophilic. Smokers in this study were defined as current or former smokers. Treatment failure was defined as a worsening of AECOPD that led to adverse clinical outcomes or required further treatment or an extended hospital stay or hospitalisation following the exacerbation. Multivariate-adjusted logistic models were used to estimate the OR and 95% CI associated with treatment failure.ResultsThere were 958 (28.2%) treatment failure events occurring. Patients with high eosinophils had a lower risk of treatment failure (OR 0.74, 95% CI 0.63 to 0.87) than patients with low eosinophils. Compared with never smoking and low eosinophilic group, the ORs for treatment failure were 0.70 (95% CI 0.52 to 0.96) for never smoking and high eosinophilic group, 0.82 (95% CI 0.64 to 1.05) for smoking and low eosinophilic group and 0.62 (95% CI 0.47 to 0.81) for smoking and high eosinophilic group. Furthermore, there was no significant interaction between eosinophils and smoking status in relation to treatment failure (p for interaction=0.73). Similar results were obtained from multiple secondary outcomes and subgroup analyses.ConclusionElevated blood eosinophils are associated with a lower rate of corticosteroid treatment failure, regardless of smoking status. Smoking does not modify the association between blood eosinophil level and corticosteroid treatment failure among inpatients with AECOPD.

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“…Since the publication of the preliminary results in June 2020, the 6 mg dexamethasone regimen became standard of care. The reason why this molecule, dose and protocol of administration were initially chosen by the RECOVERY investigators is still unclear, and the clinical community recognises the importance of a patient-tailored approach when systemic corticosteroids are used in other respiratory diseases [ 11 ]. In a recently published trial on hospitalised patients with severe COPD exacerbations a lower rate of treatment failure was found in patients with a tailored dose of systemic steroids in comparison to those treated with a fixed-dose approach [ 11 ].…”

mentioning

confidence: 99%

“…The reason why this molecule, dose and protocol of administration were initially chosen by the RECOVERY investigators is still unclear, and the clinical community recognises the importance of a patient-tailored approach when systemic corticosteroids are used in other respiratory diseases [ 11 ]. In a recently published trial on hospitalised patients with severe COPD exacerbations a lower rate of treatment failure was found in patients with a tailored dose of systemic steroids in comparison to those treated with a fixed-dose approach [ 11 ]. This experience highlighted several factors able to predict the best steroid dose, including body weight, previous use of corticosteroids, gas exchange alterations, inflammatory markers and symptomatic burden [ 11 ].…”

mentioning

confidence: 99%

“…In a recently published trial on hospitalised patients with severe COPD exacerbations a lower rate of treatment failure was found in patients with a tailored dose of systemic steroids in comparison to those treated with a fixed-dose approach [ 11 ]. This experience highlighted several factors able to predict the best steroid dose, including body weight, previous use of corticosteroids, gas exchange alterations, inflammatory markers and symptomatic burden [ 11 ].…”

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confidence: 99%

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A patient-tailored approach for corticosteroid treatment in COVID-19: still not there yet

Nigro

Chalmers²,

Aliberti³

2023

Eur Respir J

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Personalized Variable vs Fixed-Dose Systemic Corticosteroid Therapy in Hospitalized Patients With Acute Exacerbations of COPD

Cited by 18 publications

References 16 publications

Relationship Between Blood Eosinophils and Systemic Corticosteroid Therapy in COPD Exacerbation

Relationship Between Blood Eosinophils and Systemic Corticosteroid Therapy in COPD Exacerbation

Association of blood eosinophils with corticosteroid treatment failure stratified by smoking status among inpatients with AECOPD

A patient-tailored approach for corticosteroid treatment in COVID-19: still not there yet

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