TY - JOUR

T1 - Corticosteroid Resistance in Smokers

T2 - A Substudy Analysis of the CORTICO-COP Randomised Controlled Trial

AU - Sivapalan, Pradeesh

AU - Bikov, Andras

AU - Ulrik, Charlotte Suppli

AU - Lapperre, Therese Sophie

AU - Mathioudakis, Alexander G.

AU - Lassen, Mats Christian Hojberg

AU - Skaarup, Kristoffer Grundtvig

AU - Biering-Sorensen, Tor

AU - Vestbo, Jorgen

AU - Jensen, Jens-Ulrik S.

PY - 2021

Y1 - 2021

N2 - The CORTICO-COP trial showed that eosinophil-guided corticosteroid-sparing treatment for acute exacerbation of chronic obstructive pulmonary disease was non-inferior to standard of care and decreased the accumulated dose of systemic corticosteroids that patients were exposed to by approximately 60%. Smoking status has been shown to affect corticosteroid responsiveness. This post hoc analysis investigated whether eosinophil-guided treatment is non-inferior to conventional treatment in current smokers. The main analysis of current smokers showed no significant difference in the primary endpoint, days alive, and out of hospital within 14 days between the control group (mean, 9.8 days; 95% confidence interval (CI), 8.7-10.8) and the eosinophil-guided group (mean, 8.7 days; 95% CI, 7.5-9.9; p = 0.34). Secondary analyses of the number of exacerbations or deaths, the number of intensive care unit admissions or deaths, lung function improvement, and change in health-related quality of life also showed no significant differences between the two groups. The results of a sensitivity analysis of ex-smokers are consistent with the main analysis. Our results suggest that eosinophil-guided treatment is non-inferior to standard of care in current smokers and ex-smokers. Because data on the impact of smoking status on eosinophil-guided treatments are sparse, more randomised trials are needed to confirm our results.

AB - The CORTICO-COP trial showed that eosinophil-guided corticosteroid-sparing treatment for acute exacerbation of chronic obstructive pulmonary disease was non-inferior to standard of care and decreased the accumulated dose of systemic corticosteroids that patients were exposed to by approximately 60%. Smoking status has been shown to affect corticosteroid responsiveness. This post hoc analysis investigated whether eosinophil-guided treatment is non-inferior to conventional treatment in current smokers. The main analysis of current smokers showed no significant difference in the primary endpoint, days alive, and out of hospital within 14 days between the control group (mean, 9.8 days; 95% confidence interval (CI), 8.7-10.8) and the eosinophil-guided group (mean, 8.7 days; 95% CI, 7.5-9.9; p = 0.34). Secondary analyses of the number of exacerbations or deaths, the number of intensive care unit admissions or deaths, lung function improvement, and change in health-related quality of life also showed no significant differences between the two groups. The results of a sensitivity analysis of ex-smokers are consistent with the main analysis. Our results suggest that eosinophil-guided treatment is non-inferior to standard of care in current smokers and ex-smokers. Because data on the impact of smoking status on eosinophil-guided treatments are sparse, more randomised trials are needed to confirm our results.

KW - chronic obstructive pulmonary disease

KW - corticosteroid resistance

KW - smoking

KW - airway inflammation

KW - blood eosinophils

KW - OBSTRUCTIVE PULMONARY-DISEASE

KW - INHALED CORTICOSTEROIDS

KW - ORAL CORTICOSTEROIDS

KW - SHORT-TERM

KW - EXACERBATIONS

KW - THERAPY

KW - INFLAMMATION

KW - SMOKING

KW - ASTHMA

U2 - 10.3390/jcm10122734

DO - 10.3390/jcm10122734

M3 - Journal article

C2 - 34205765

VL - 10

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

SN - 2077-0383

IS - 12

M1 - 2734

ER -