A systematic review of blood eosinophils and continued treatment with inhaled corticosteroids in patients with COPD
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A systematic review of blood eosinophils and continued treatment with inhaled corticosteroids in patients with COPD. / Dalin, Dagmar Abelone; Løkke, Anders; Kristiansen, Pernille; Jensen, Charlotte; Birkefoss, Kirsten; Christensen, Hanne Rolighed; Godtfredsen, Nina Skavlan; Hilberg, Ole; Rohde, Jeanett Friis; Ussing, Anja; Vermehren, Charlotte; Händel, Mina Nicole.
In: Respiratory Medicine, Vol. 198, 106880, 2022.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - A systematic review of blood eosinophils and continued treatment with inhaled corticosteroids in patients with COPD
AU - Dalin, Dagmar Abelone
AU - Løkke, Anders
AU - Kristiansen, Pernille
AU - Jensen, Charlotte
AU - Birkefoss, Kirsten
AU - Christensen, Hanne Rolighed
AU - Godtfredsen, Nina Skavlan
AU - Hilberg, Ole
AU - Rohde, Jeanett Friis
AU - Ussing, Anja
AU - Vermehren, Charlotte
AU - Händel, Mina Nicole
N1 - Funding Information: Funding: This study was supported by the Danish Health Authority [ 05-0000-29 ].
PY - 2022
Y1 - 2022
N2 - Inhaled corticosteroid (ICS) in patients with chronic obstructive pulmonary disease (COPD) has been debated for 20 years. In our systematic literature review and meta-analysis, we addressed the following: Should patients with COPD and a blood eosinophil count (EOS) of, respectively, a) < 150 cells/μl, b) 150–300 cells/μl, and c) > 300 cells/μl continue treatment with ICS? Protocol registered in PROSPERO (CRD42020178110) and funded by the Danish Health Authority. We searched Medline, Embase, CINAHL and Cochrane Central on 22nd July 2020 for randomized controlled trials (RCT) of ICS treatment in patients with COPD (≥40 years, no current asthma), which analyzed outcomes by EOS count and where >50% of patients used ICS prior. We used the GRADE method. Meta-analyzes for the outcomes were divided into EOS subgroups and analyzed for differences. We identified 11 RCTs with a total of 29,654 patients. A significant difference (p < 0.00001) between the three subgroups’ reduction of risk of moderate to severe exacerbation was found. Rate ratios for EOS counts: <150 cells/μL was 0.88 (95%CI: 0.83, 0.94); 150–300 cells/μL was 0.80 (95%CI: 0.69, 0.94); >300 cells/μL was 0.57 (95%CI: 0.49, 0.66). Overall, the certainty of the effect estimates was low to very low due to risk of bias, unexplained heterogeneity, few RCTs, and wide confidence intervals. A clear correlation was demonstrated between effect of continued ICS treatment (number of exacerbations, lung function, and quality of life) and increasing EOS count. Our meta-analyses suggested that treatment with ICS seemed beneficial for everyone except patients with EOS count below 150 cells/μl.
AB - Inhaled corticosteroid (ICS) in patients with chronic obstructive pulmonary disease (COPD) has been debated for 20 years. In our systematic literature review and meta-analysis, we addressed the following: Should patients with COPD and a blood eosinophil count (EOS) of, respectively, a) < 150 cells/μl, b) 150–300 cells/μl, and c) > 300 cells/μl continue treatment with ICS? Protocol registered in PROSPERO (CRD42020178110) and funded by the Danish Health Authority. We searched Medline, Embase, CINAHL and Cochrane Central on 22nd July 2020 for randomized controlled trials (RCT) of ICS treatment in patients with COPD (≥40 years, no current asthma), which analyzed outcomes by EOS count and where >50% of patients used ICS prior. We used the GRADE method. Meta-analyzes for the outcomes were divided into EOS subgroups and analyzed for differences. We identified 11 RCTs with a total of 29,654 patients. A significant difference (p < 0.00001) between the three subgroups’ reduction of risk of moderate to severe exacerbation was found. Rate ratios for EOS counts: <150 cells/μL was 0.88 (95%CI: 0.83, 0.94); 150–300 cells/μL was 0.80 (95%CI: 0.69, 0.94); >300 cells/μL was 0.57 (95%CI: 0.49, 0.66). Overall, the certainty of the effect estimates was low to very low due to risk of bias, unexplained heterogeneity, few RCTs, and wide confidence intervals. A clear correlation was demonstrated between effect of continued ICS treatment (number of exacerbations, lung function, and quality of life) and increasing EOS count. Our meta-analyses suggested that treatment with ICS seemed beneficial for everyone except patients with EOS count below 150 cells/μl.
KW - Blood eosinophils
KW - Chronic obstructive pulmonary disease
KW - Eosinophil
KW - Inhaled corticosteroid
U2 - 10.1016/j.rmed.2022.106880
DO - 10.1016/j.rmed.2022.106880
M3 - Review
C2 - 35599064
AN - SCOPUS:85130481695
VL - 198
JO - Respiratory Medicine
JF - Respiratory Medicine
SN - 0954-6111
M1 - 106880
ER -
ID: 309270344