New Findings Add to Current Debate About Use of ICS Therapy in COPD

Eosinophil count helps identify ICS nonresponders

A new data analysis has shown that levels of eosinophils can help identify patients with chronic obstructive pulmonary disease (COPD) who may or may not benefit from the addition of inhaled corticosteroid (ICS) treatment. The post hoc analysis was published online in Lancet Respiratory Medicine.

The 52-week WISDOM trial evaluated the effect of ICS withdrawal in patients with severe to very severe COPD with a history of exacerbation, while receiving treatment with the Spiriva Handihaler (Boehringer Ingelheim)—a long-acting muscarinic antagonist (LAMA)—plus a long-acting beta2-agonist (LABA). For 80% of the patients enrolled in this study, the analysis showed that the use of ICS on top of the Spiriva Handihaler and a LABA had no additional benefit in reducing the risk of exacerbations or “flare-ups” compared with LAMA/LABA therapy without ICS.

The analysis also found that these patients can be identified by measuring the level of eosinophils in their blood. Eosinophil levels below 4% (300 cells/mcL) were associated with a lack of response to ICS.

Exacerbations significantly contribute to the effect of COPD; often lead to patients being admitted to hospitals; and can increase the risk of patients dying. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends the use of ICS-containing therapy only in COPD patients with severe to very severe lung-function impairment and/or at high risk of exacerbations—the population studied in the WISDOM trial. Even within this severe population, only a small minority of patients in the study benefited from the inclusion of ICS in their treatment regimens. It is known that long-term use of ICS treatments may be associated with a risk of serious adverse events, including pneumonia, osteoporosis, and diabetes onset and progression.

The WISDOM post hoc analysis demonstrated that using the commonly performed eosinophil blood count may provide a practical tool to help health care providers identify the small subset of patients who may benefit from the addition of ICS to treatment with the Spiriva Handihaler plus a LABA.

“Long-acting bronchodilators are a mainstay therapy in COPD management; however, in clinical practice, ICS is widely used across all COPD stages,” said investigator Professor Peter Calverley of the University of Liverpool in the United Kingdom. “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 long-term side effects of ICS use.”

Source: Boehringer Ingelheim; April 8, 2016.