Evaluating blood eosinophils and exacerbation history to predict ICS response in COPD
23 February 2017 (online)
Inhaled corticosteroids (ICS) are used to reduce the rate of COPD exacerbations (EX). Debate continues over use of blood eosinophils (EOS) to predict ICS response, with some suggesting a cut-off of ≥2% (Pascoe S et al. Lancet Respir Med 2015;3:435 – 42). In the WISDOM study (NCT00975195), this response was driven by patients with higher EOS levels (≥4% or ≥300 cells/µL) (Watz H et al. Lancet Respir Med 2016;4:390 – 8]).
We analysed WISDOM data stratified by prior EX and EOS levels to determine if the ICS responder group could be better specified.
Post hoc analysis of the rate of moderate/severe EX after complete ICS withdrawal using a negative binomial regression model to estimate EX rate according to number of prior EX (< 2 and ≥2, estimated based on the number of courses of antibiotics or steroids in the past year) and EOS subgroups.
High EOS counts (≥400 cells/µL) were associated with increased EX rate after complete ICS withdrawal only in patients with ≥2 prior EX (Figure).
Withdrawal of ICS only increased the rate of EX in patients with both raised EOS (≥400 cells/µL) and a history of frequent EX. In patients who do not meet these criteria, ICS may not be as effective as is commonly assumed.
Content already presented at ERS congress 2016