Blood eosinophils to guide inhaled maintenance therapy in a primary care COPD population
Ashdown HF., Smith M., McFadden E., Pavord ID., Butler CC., Bafadhel M.
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 ≥40 years with COPD, 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/µL) and “low” (<150/µL) groups).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 non-ICS, but with a lower risk in those with “high” eosinophils (hazard ratio 1.04, 95% CI 0.98 to 1.10) than “low” eosinophils (1.19, 95% CI 1.09 to 1.31) (p value for interaction=0.01). Risk of pneumonia hospitalisation with ICS was greatest in those with “low” eosinophils (hazard ratio 1.26, 95% CI 1.05 to 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/µL).