Eosinophil-guided corticosteroid therapy in patients admitted for COPD exacerbation

  • Sivapalan P & al.
  • Lancet Respir Med
  • 1 Aug 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with severe acute exacerbations of chronic obstructive pulmonary disease (COPD) requiring hospital admission, an eosinophil-guided therapy was non-inferior to standard care for the number of days alive and out of hospital.
  • Eosinophil-guided therapy reduced the duration of systemic corticosteroid exposure to less than half vs the standard care.

Why this matters

  • Findings suggest eosinophil-guided therapy might improve patient care and clinical practice in patients with COPD exacerbations.
  • Larger studies would help to determine the full safety profile of this strategy.

Study design

  • 318 patients (age, ≥40 years) with acute exacerbations of COPD were randomly assigned to receive eosinophil-guided therapy (n=159) and standard therapy with systemic corticosteroids (n=159).
  • Primary outcome: number of days alive and out of hospital within 14 days after recruitment assessed using intention-to-treat analysis.
  • Funding: The Danish Regions Medical Fund and the Danish Council for Independent Research.

Key results

  • Eosinophil-guided group vs the control group showed no significant difference in:
    • days alive and out of hospital within 14 days after recruitment (mean, 8.9 vs 9.3 days; absolute difference, −0.4; 95% CI, −1.3 to 0.5; P=.34).
    • treatment failure at 30 days (42 vs 41 patients; absolute difference, 0.6%; 95% CI, −9.0 to 10.3; P=.90).
  • After 30 days, 9 patients died in the eosinophil-guided group vs 6 in the control group (absolute difference, 1.9%; 95% CI, −2.8 to 6.5; P=.43).
  • Eosinophil-guided group vs control group had a lower median duration of systemic corticosteroid therapy (2 [interquartile range {IQR}, 1.0-3.0] days vs 5 [IQR, 5.0-5.0] days; P<.0001>

Limitations

  • Study did not have sufficient power to detect differences in mortality rate.

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