Blood Eosinophils and response to maintenance COPD treatment: data from the FLAME trial

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Title: Blood Eosinophils and response to maintenance COPD treatment: data from the FLAME trial
Authors: Roche, N
Chapman, KR
Vogelmeier, CF
Herth, FJ
Thach, C
Fogel, R
Olsson, P
Patalano, F
Banerji, D
Wedzicha, JA
Item Type: Journal Article
Abstract: Rationale: Post hoc analyses suggest that blood eosinophils have potential as a predictive biomarker of inhaled corticosteroid efficacy in the management of chronic obstructive pulmonary disease (COPD). Objectives: We prospectively investigated the value of blood eosinophils as a predictor of responsiveness to an inhaled corticosteroid/long-acting β2-agonist combination versus a long-acting β2-agonist/long-acting muscarinic antagonist combination for exacerbation prevention. Methods: We conducted prespecified analyses of data from the FLAME (Effect of Indacaterol Glycopyronium vs Fluticasone Salmeterol on COPD Exacerbations) study, which compared once-daily long-acting β2-agonist/long-acting muscarinic antagonist indacaterol/glycopyrronium 110/50 μg with twice-daily long-acting β2-agonist/inhaled corticosteroid salmeterol/fluticasone combination 50/500 μg in patients with one or more exacerbations in the preceding year. Subsequent post hoc analyses were conducted to address further cutoffs and endpoints. Measurements and Main Results: We compared treatment efficacy according to blood eosinophil percentage (<2% and ≥2%, <3% and ≥3%, and <5% and ≥5%) and absolute blood eosinophil count (<150 cells/μl, 150 to <300 cells/μl, and ≥300 cells/μl). Indacaterol/glycopyrronium was significantly superior to salmeterol/fluticasone for the prevention of exacerbations (all severities, or moderate or severe) in the <2%, ≥2%, <3%, <5%, and <150 cells/μl subgroups, and at no cutoff was salmeterol/fluticasone superior to indacaterol/glycopyrronium. Furthermore, the rate of moderate or severe exacerbations did not increase with increasing blood eosinophils. The incidence of pneumonia was higher in patients receiving salmeterol/fluticasone than indacaterol/glycopyrronium in both the <2% and ≥2% subgroups. Conclusions: Our prospective analyses indicate that indacaterol/glycopyrronium provides superior or similar benefits over salmeterol/fluticasone regardless of blood eosinophil levels in patients with COPD.
Issue Date: 1-May-2017
Date of Acceptance: 7-Mar-2017
ISSN: 1535-4970
Publisher: American Thoracic Society
Start Page: 1189
End Page: 1197
Journal / Book Title: American Journal of Respiratory and Critical Care Medicine
Volume: 195
Issue: 9
Copyright Statement: © 2017 by the American Thoracic Society
Sponsor/Funder: Royal Brompton & Harefield NHS Foundation Trust
Medical Research Council (MRC)
Funder's Grant Number: RCF funding from LNW CRN
Keywords: Respiratory System
11 Medical And Health Sciences
Publication Status: Published
Appears in Collections:National Heart and Lung Institute

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