Blood eosinophils and response to maintenance chronic obstructive pulmonary disease treatment: data from the FLAME trial
Rationale: Post hoc analyses suggest that blood eosinophils have potential as a predictive biomarker of inhaled corticosteroid efficacy in the management of chronic obstructive pulmonary disease (COPD).Objectives: We prospectively investigated the value of blood eosinophils as a predictor of respons...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
March 9, 2017
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| In: |
American journal of respiratory and critical care medicine
Year: 2017, Volume: 195, Issue: 9, Pages: 1189-1197 |
| ISSN: | 1535-4970 |
| DOI: | 10.1164/rccm.201701-0193OC |
| Online Access: | Verlag, kostenfrei, Volltext: http://dx.doi.org/10.1164/rccm.201701-0193OC Verlag, kostenfrei, Volltext: https://www.atsjournals.org/doi/abs/10.1164/rccm.201701-0193OC 
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| Author Notes: | Nicolas Roche, Kenneth R. Chapman, Claus F. Vogelmeier, Felix J.F. Herth, Chau Thach, Robert Fogel, Petter Olsson, Francesco Patalano, Donald Banerji, and Jadwiga A. Wedzicha |
| Summary: | Rationale: Post hoc analyses suggest that blood eosinophils have potential as a predictive biomarker of inhaled corticosteroid efficacy in the management of chronic obstructive pulmonary disease (COPD).Objectives: We prospectively investigated the value of blood eosinophils as a predictor of responsiveness to an inhaled corticosteroid/long-acting β2-agonist combination versus a long-acting β2-agonist/long-acting muscarinic antagonist combination for exacerbation prevention.Methods: We conducted prespecified analyses of data from the FLAME (Effect of Indacaterol Glycopyronium vs Fluticasone Salmeterol on COPD Exacerbations) study, which compared once-daily long-acting β2-agonist/long-acting muscarinic antagonist indacaterol/glycopyrronium 110/50 μg with twice-daily long-acting β2-agonist/inhaled corticosteroid salmeterol/fluticasone combination 50/500 μg in patients with one or more exacerbations in the preceding year. Subsequent post hoc analyses were conducted to address further cutoffs and endpoints.Measurements and Main Results: We compared treatment efficacy according to blood eosinophil percentage (<2% and ≥2%, <3% and ≥3%, and <5% and ≥5%) and absolute blood eosinophil count (<150 cells/μl, 150 to <300 cells/μl, and ≥300 cells/μl). Indacaterol/glycopyrronium was significantly superior to salmeterol/fluticasone for the prevention of exacerbations (all severities, or moderate or severe) in the <2%, ≥2%, <3%, <5%, and <150 cells/μl subgroups, and at no cutoff was salmeterol/fluticasone superior to indacaterol/glycopyrronium. Furthermore, the rate of moderate or severe exacerbations did not increase with increasing blood eosinophils. The incidence of pneumonia was higher in patients receiving salmeterol/fluticasone than indacaterol/glycopyrronium in both the <2% and ≥2% subgroups.Conclusions: Our prospective analyses indicate that indacaterol/glycopyrronium provides superior or similar benefits over salmeterol/fluticasone regardless of blood eosinophil levels in patients with COPD.Clinical trial registered with www.clinicaltrials.gov (NCT01782326). |
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| Item Description: | Gesehen am 10.07.2018 |
| Physical Description: | Online Resource |
| ISSN: | 1535-4970 |
| DOI: | 10.1164/rccm.201701-0193OC |