Corticosteroid Resistance in Smokers: A Substudy Analysis of the CORTICO-COP Randomised Controlled Trial
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Corticosteroid Resistance in Smokers : A Substudy Analysis of the CORTICO-COP Randomised Controlled Trial. / Sivapalan, Pradeesh; Bikov, Andras; Ulrik, Charlotte Suppli; Lapperre, Therese Sophie; Mathioudakis, Alexander G.; Lassen, Mats Christian Hojberg; Skaarup, Kristoffer Grundtvig; Biering-Sorensen, Tor; Vestbo, Jorgen; Jensen, Jens-Ulrik S.
I: Journal of Clinical Medicine, Bind 10, Nr. 12, 2734, 2021.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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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 -
ID: 274280102