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
AU - Højberg Lassen, Mats Christian
AU - Grundtvig Skaarup, Kristoffer
AU - Biering-sørensen, Tor
AU - Vestbo, Jørgen
AU - Jensen, Jens Ulrik Stæhr
PY - 2021/6/21
Y1 - 2021/6/21
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 differ-ence 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 smok-ers 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 differ-ence 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 smok-ers 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
UR - https://doi.org/10.3390/jcm10122734
U2 - 10.3390/jcm10122734
DO - 10.3390/jcm10122734
M3 - Article
SN - 2077-0383
VL - 10
SP - 1
EP - 11
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 12
M1 - 2734
ER -