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Absolute blood eosinophil counts to guide inhaled corticosteroids therapy among patients with COPD: Systematic review and meta-analysis

Citation

Oshagbemi, OA and Odiba, JO and Daniel, A and Yunusa, I, Absolute blood eosinophil counts to guide inhaled corticosteroids therapy among patients with COPD: Systematic review and meta-analysis, Current Drug Targets, 20, (16) pp. 1670-1679. ISSN 1389-4501 (2019) [Refereed Article]

Copyright Statement

2019 Bentham Science Publishers

DOI: doi:10.2174/1389450120666190808141625

Abstract

Introduction: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019 recommends the use of absolute blood eosinophil count as a guide for the escalation and de-escalation of inhaled corticosteroids (ICS) in the pharmacological management of patients with chronic obstructive pulmonary disease (COPD). We evaluated the risk of moderate or severe exacerbations among patients escalating and de-escalating ICS therapy by absolute blood eosinophil thresholds in this systematic review.

Methods: Through a comprehensive literature search of Pubmed/MEDLINE, EMBASE, and clinical trial sites up to April 2019, we identified relevant studies. We used generic inverse variance method with fixed-effects estimates to compare the risk of moderate or severe exacerbations among COPD patients with elevated blood eosinophil counts exposed to inhaled corticosteroids (ICS) versus non-ICS treatments groups expressed as risk ratios.

Results: Ten studies (8 randomised control trials and 2 observational studies) were included, with a total of 85,059 COPD patients. In our pooled analysis, we found an overall reduction in risk of moderate or severe exacerbations in patients with absolute blood eosinophil thresholds ranging from ≥ 100 to ≥ 340 cells/無 among patients escalating ICS (RR, 0.77, 95% CI, 0.73-0.81). For studies evaluating the effects of de-escalation of ICS on moderate to severe exacerbations using blood eosinophil thresholds of ≥ 300 to ≥ 340 cells/無 had an increased risk of moderate or severe exacerbations following the de-escalation of ICS (RR, 1.66, 95% CI, 1.31-2.10).

Conclusion: This study confirms the validity of the recommended absolute blood eosinophil count thresholds for the escalation and de-escalation of ICS among COPD patients. However, this recommendation is for COPD patients with prior exacerbations rather than among newly diagnosed COPD patients as observed in this study. COPD patients with current or past history of asthma represent a unique phenotypic group which should be further evaluated.

Item Details

Item Type:Refereed Article
Keywords:chronic obstructive pulmonary disease, blood eosinophils, exacerbations, inhaled corticosteroids, eosinophil, pharmacological
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Respiratory diseases
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Daniel, A (Mr Abraham Daniel)
ID Code:136989
Year Published:2019
Web of Science® Times Cited:4
Deposited By:UTAS Centre for Rural Health
Deposited On:2020-01-24
Last Modified:2020-07-27
Downloads:0

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