Boehringer Ingelheim recently announced that a new study showed that the levels of specific white blood cells (eosinophils) can help to identify patients with chronic obstructive pulmonary disease (COPD) who may benefit from corticosteroid treatment.
In 80 percent of the patients analyzed in the WISDOM study, the use of corticosteroids on top of Spiriva and a long-acting beta agonist (LABA) had no additional benefit in reducing the risk of exacerbations. or flare-ups.
The article, “Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids: a post-hoc analysis of the WISDOM trial,” was published in the journal The Lancet Respiratory Medicine.
Regular use of inhaled corticosteroids (ICS), either alone or in combination with a LABA, has been reported to reduce the risk of COPD exacerbations. And, blood eosinophil counts have been suggested to be predictive of the response to ICS in patients with COPD and a history of exacerbations.
To assess whether patients with COPD with higher blood eosinophil counts would be more likely to have exacerbations if ICS treatment was withdrawn, the research team used data from the WISDOM study, a 12-month, randomized, parallel-group trial in which patients received 18 μg tiotropium, 100 μg salmeterol, and 1,000 μg fluticasone propionate daily for six weeks, and were then randomly assigned electronically (1:1) to receive either continued or reduced ICS over 12 weeks.
A post-hoc analysis was performed after complete ICS withdrawal (months 3-12) to compare rate of exacerbations and time to exacerbation outcomes on the basis of blood eosinophil subgroups.
The post-hoc analysis of the WISDOM trial results showed that for 80 percent of the patients, the use of ICS on top of Spiriva and a LABA had no additional benefit in reducing the risk of exacerbations, or flare-ups, compared to Spiriva and a LABA without ICS. In addition, 20 percent of the patients who benefited from a reduced exacerbation risk due to the continued use of ICS combined with Spiriva and a LABA had higher levels of blood eosinophils (greater than or equal to 300 cells/µL; more than 4 percent).
“These results are thought-provoking and add to the current debate about the appropriate use of ICS therapy in COPD,” Dr. William Mezzanotte, vice president and head of respiratory medicine at Boehringer Ingelheim, said in a press release. “We look forward to further discussion and investigation of this important topic.“
“Long-acting bronchodilators are a mainstay therapy in COPD management, however in clinical practice ICS is widely used across all COPD stages,” said study investigator Peter Calverley, professor of pulmonary and rehabilitation medicine at the University of Liverpool in England.
“Previously, it has been difficult to determine the subset of patients who respond to ICS. These findings will help physicians more confidently identify which patients may benefit from ICS therapy, helping minimize exposure to the risk of side effects related to long-term ICS use,” Calverley said.
The findings need to be confirmed in appropriately stratified prospective clinical trials. Until such data are available, researchers believe there is a plausible argument that long-acting bronchodilator use is at least as effective as ICS/LABA in preventing exacerbations in most patients who meet the inclusion criteria of the WISDOM study.