Blood eosinophils and inhaled corticosteroid/long-acting β-2 agonist efficacy in COPD.
Blood eosinophils and inhaled corticosteroid/long-acting β-2 agonist efficacy in COPD.
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DOI：
10.1136/thoraxjnl-2015-207021
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发表时间：
2016-02
期刊：
影响因子：
10
通讯作者：
Barnes NC
中科院分区：
文献类型：
--
作者：
Pavord ID;Lettis S;Locantore N;Pascoe S;Jones PW;Wedzicha JA;Barnes NC
我们对丙酸氟替卡松（FP）/沙美特罗（SAL）（联合吸入性皮质类固醇（ICS）/长效β2-激动剂（LABA））治疗COPD患者的研究进行了综述，这些研究测量了基线（治疗前）血嗜酸性粒细胞水平，以检测血嗜酸性粒细胞水平≥2%是否与ICS治疗后加重率的较大降低相关。3项持续时间≥1年的研究符合入选标准。根据基线血嗜酸性粒细胞水平（<2% vs ≥2%）分析中度和重度急性发作率。基线时，57-75%的患者血嗜酸性粒细胞≥2%。通过嗜酸性粒细胞水平比较FEV 1和St乔治呼吸问卷（SGRQ）评分的变化。对于嗜酸性粒细胞≥2%的患者，与噻托溴铵（INSPIRE：n=719，率比（RR）=0.75，95% CI 0.60 - 0.92，p=0.006）和安慰剂（TRISTAN：n=1049，RR=0.63，95% CI 0.50 - 0.79，p<0.001）相比，FP/SAL与急性加重率显著降低相关。两项研究中嗜酸性粒细胞<2%亚组无显著差异（INSPIRE：n=550，RR=1.18，95% CI 0.92 - 1.51，p=0.186; TRISTAN：n=354，RR=0.99，95% CI 0.67 - 1.47，p=0.957）。在SCO 30002（n=373）中，未观察到显著效应（FP或FP/SAL vs安慰剂）。在任何研究中均未观察到嗜酸性粒细胞亚群与对FEV 1和SGRQ的治疗效应之间存在相关性。基线血嗜酸性粒细胞水平可能代表有中度/重度急性加重史的COPD患者使用ICS/LABA后急性加重减少的信息标志物。
We performed a review of studies of fluticasone propionate (FP)/salmeterol (SAL) (combination inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA)) in patients with COPD, which measured baseline (pretreatment) blood eosinophil levels, to test whether blood eosinophil levels ≥2% were associated with a greater reduction in exacerbation rates with ICS therapy. Three studies of ≥1-year duration met the inclusion criteria. Moderate and severe exacerbation rates were analysed according to baseline blood eosinophil levels (<2% vs ≥2%). At baseline, 57–75% of patients had ≥2% blood eosinophils. Changes in FEV1 and St George's Respiratory Questionnaire (SGRQ) scores were compared by eosinophil level. For patients with ≥2% eosinophils, FP/SAL was associated with significant reductions in exacerbation rates versus tiotropium (INSPIRE: n=719, rate ratio (RR)=0.75, 95% CI 0.60 to 0.92, p=0.006) and versus placebo (TRISTAN: n=1049, RR=0.63, 95% CI 0.50 to 0.79, p<0.001). No significant difference was seen in the <2% eosinophil subgroup in either study (INSPIRE: n=550, RR=1.18, 95% CI 0.92 to 1.51, p=0.186; TRISTAN: n=354, RR=0.99, 95% CI 0.67 to 1.47, p=0.957, respectively). In SCO30002 (n=373), no significant effects were observed (FP or FP/SAL vs placebo). No relationship was observed in any study between eosinophil subgroup and treatment effect on FEV1 and SGRQ. Baseline blood eosinophil levels may represent an informative marker for exacerbation reduction with ICS/LABA in patients with COPD and a history of moderate/severe exacerbations.