Screennig eosinophil counts and risk of exacerbations after inhaled corticosteroid withdrawal in severe COPD
23 February 2017 (online)
Blood eosinophil counts may predict response to inhaled corticosteroids (ICS) in patients with COPD with a history of exacerbations.
To investigate if higher screening blood eosinophil counts were associated with more exacerbations after ICS withdrawal in the WISDOM study.
In WISDOM (NCT00975195; 12-month, randomised, parallel-group study), patients with severe to very severe COPD and a history of exacerbations received 18 µg tiotropium, 100 µg salmeterol and 1000 µg fluticasone propionate daily for 6 weeks then continued or reduced ICS over the next 12 weeks. This post hoc analysis after complete ICS withdrawal compared exacerbation outcomes based on analysis of mutually exclusive blood eosinophil subgroups.
2296 patients were followed post-ICS withdrawal. Moderate or severe exacerbation rate ratios were similar in patients with eosinophil counts < 2%, ≥2-< 3%, ≥3-< 4%, < 150 cells/µL or 150-< 300 cells/µL (Figure). Exacerbation rate increased in the ICS-withdrawal versus the ICS arm for blood eosinophil subgroups ≥4-< 5%, ≥5-< 6%, ≥6%, ≥300-< 400 cells/µL and ≥400 cells/µL, reaching statistical significance in the ≥5-< 6% and ≥400 cells/µL subgroups.
In WISDOM, high screening blood eosinophil count (≥4% or ≥300 cells/µL) predicted an increased exacerbation risk in patients with severe to very severe COPD after ICS withdrawal.
Content already presented at ERS congress 2016