Key factors affect net clinical benefit of add-on inhaled corticosteroids to COPD therapy
Predictors of the net clinical benefit of adding inhaled corticosteroids to long-acting muscarinic antagonist and long-acting beta agonist therapy may help personalize treatment decisions for patients with COPD.
“Our results show that three key factors influence the balance of treatment benefits and side effects of adding different doses of inhaled corticosteroid: the risk of exacerbation, the amount of certain blood cells and the patient’s age,” Henock G. Yebyo, PhD, postdoctoral researcher at the Epidemiology, Biostatistics and Prevention Institute of the University of Zurich, said in a related press release
Researchers conducted analyses that considered the effects of low to moderate inhaled corticosteroid (ICS), LABA and LAMA doses, compared with LABA and LAMA only, as well as the incidence of outcomes in a benefit-harm modeling study. The researchers used exponential models to estimate the 2-year net clinical benefit of add-on treatment with ICS.
In patients with a 2-year baseline COPD exacerbation risk of 54% to 83%, adding low to moderate ICS doses to LABA and LAMA treatment demonstrated a clinical benefit. Adding low-dose ICS provided net clinical benefit if a patient’s baseline risk was 40% to 91%; however, the same was not observed with higher ICS doses, according to the results.
This benefit was modified by age and blood eosinophil count, according to the researchers.
The researchers reported a net clinical benefit from treatment with low-dose ICS in patients with a blood eosinophil count of 150 cells/L or more, with a 2-year exacerbation risk of 32% to 95% among patients aged 40 to 79 years and with a 2-year exacerbation risk of 41% to 93% among patients older than 80 years. There was no net benefit associated with a blood eosinophil count of less than 150 cells/L, according to the results.
In patients younger than 80 years with a blood eosinophil count of 150 cells/L or more and a 2-year exacerbation risk of 52% to 86%, adding moderate-dose ICS was associated with net clinical benefit.
According to the researchers, the proportion of patients with a net benefit from the addition of ICS ranged from 0% to 68% depending on the subgroup, but these proportions were qualitatively similar between subgroups and varied ICS doses when using the American Thoracic Society guideline recommendations.
“With the use of these factors and a model for predicting exacerbation risk, the uncertainty about when to prescribe inhaled corticosteroids and at what dose can be substantially reduced, and overtreatment and undertreatment with inhaled corticosteroids minimized,” the researchers wrote.