Blood eosinophils to guide inhaled maintenance therapy in a primary care COPD population

TY - JOUR

T1 - Blood eosinophils to guide inhaled maintenance therapy in a primary care COPD population

AU - Ashdown, Helen F.

AU - Smith, Margaret

AU - McFadden, Emily

AU - Pavord, Ian D.

AU - Butler, Chris C.

AU - Bafadhel, Mona

N1 - Funding Information: Support statement: This work was funded by a personal fellowship from the National Institute for Health Research (NIHR) awarded to H.F. Ashdown (DRF 2014-07-052). M. Smith and I.D. Pavord are supported by the NIHR Oxford Biomedical Research Centre. The funder had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The funder will approve the manuscript before publication. The researchers are independent from funders; and all authors had full access to all of the data in the study, and can take responsibility for the integrity of the data and the accuracy of the data analysis. The views expressed are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care. This work used data provided by patients and collected by the NHS as part of their care and support, and would not have been possible without access to these data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The interpretation and conclusions contained in this study are those of the authors alone. Funding information for this article has been deposited with the Crossref Funder Registry. Funding Information: This work was funded by a personal fellowship from the National Institute for Health Research (NIHR) awarded to H.F. Ashdown (DRF 2014-07-052). M. Smith and I.D. Pavord are supported by the NIHR Oxford Biomedical Research Centre. The funder had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The funder will approve the manuscript before publication. The researchers are independent from funders; and all authors had full access to all of the data in the study, and can take responsibility for the integrity of the data and the accuracy of the data analysis. The views expressed are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care. This work used data provided by patients and collected by the NHS as part of their care and support, and would not have been possible without access to these data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The interpretation and conclusions contained in this study are those of the authors alone. Publisher Copyright: © The authors 2022.

PY - 2022/1

Y1 - 2022/1

N2 - Blood eosinophils are a potentially useful biomarker for guiding inhaled corticosteroid (ICS) treatment decisions in COPD. We investigated whether existing blood eosinophil counts predict benefit from initiation of ICS compared to bronchodilator therapy. We used routinely collected data from UK primary care in the Clinical Practice Research Datalink. Participants were aged ⩾40 years with COPD, were ICS-naïve and starting a new inhaled maintenance medication (intervention group: ICS; comparator group: long-acting bronchodilator, non-ICS). Primary outcome was time to first exacerbation, compared between ICS and non-ICS groups, stratified by blood eosinophils (“high” ⩾150 cells·µL−1 and “low” <150 cells·µL−1 ). Out of 9475 eligible patients, 53.9% initiated ICS and 46.1% non-ICS treatment with no difference in eosinophils between treatment groups ( p=0.71). Exacerbation risk was higher in patients prescribed ICS than those prescribed non-ICS treatment, but with a lower risk in those with high eosinophils (hazard ratio (HR) 1.04, 95% CI 0.98–1.10) than low eosinophils (HR 1.19, 95% CI 1.09–1.31) ( p-value for interaction 0.01). Risk of pneumonia hospitalisation with ICS was greatest in those with low eosinophils (HR 1.26, 95% CI 1.05–1.50; p-value for interaction 0.04). Results were similar whether the most recent blood eosinophil count or the mean of blood eosinophil counts was used. In a primary care population, the most recent blood eosinophil count could be used to guide initiation of ICS in COPD patients. We suggest that ICS should be considered in those with higher eosinophils and avoided in those with lower eosinophils (<150 cells·µL−1).

AB - Blood eosinophils are a potentially useful biomarker for guiding inhaled corticosteroid (ICS) treatment decisions in COPD. We investigated whether existing blood eosinophil counts predict benefit from initiation of ICS compared to bronchodilator therapy. We used routinely collected data from UK primary care in the Clinical Practice Research Datalink. Participants were aged ⩾40 years with COPD, were ICS-naïve and starting a new inhaled maintenance medication (intervention group: ICS; comparator group: long-acting bronchodilator, non-ICS). Primary outcome was time to first exacerbation, compared between ICS and non-ICS groups, stratified by blood eosinophils (“high” ⩾150 cells·µL−1 and “low” <150 cells·µL−1 ). Out of 9475 eligible patients, 53.9% initiated ICS and 46.1% non-ICS treatment with no difference in eosinophils between treatment groups ( p=0.71). Exacerbation risk was higher in patients prescribed ICS than those prescribed non-ICS treatment, but with a lower risk in those with high eosinophils (hazard ratio (HR) 1.04, 95% CI 0.98–1.10) than low eosinophils (HR 1.19, 95% CI 1.09–1.31) ( p-value for interaction 0.01). Risk of pneumonia hospitalisation with ICS was greatest in those with low eosinophils (HR 1.26, 95% CI 1.05–1.50; p-value for interaction 0.04). Results were similar whether the most recent blood eosinophil count or the mean of blood eosinophil counts was used. In a primary care population, the most recent blood eosinophil count could be used to guide initiation of ICS in COPD patients. We suggest that ICS should be considered in those with higher eosinophils and avoided in those with lower eosinophils (<150 cells·µL−1).

UR - http://www.scopus.com/inward/record.url?scp=85124815181&partnerID=8YFLogxK

U2 - 10.1183/23120541.00606-2021

DO - 10.1183/23120541.00606-2021

M3 - Article

AN - SCOPUS:85124815181

SN - 2312-0541

VL - 8

JO - ERJ Open Research

JF - ERJ Open Research

IS - 1

M1 - 00606-2021

ER -