Boehringer Ingelheim announced new data showing that the level of eosinophils can help identify patients with chronic obstructive pulmonary disease (COPD) who may and may not benefit from adding inhaled corticosteroid (ICS) treatment. The full findings are published in Lancet Respiratory Medicine.

WISDOM was a 52-week, large-scale study that evaluated the effect of ICS withdrawal in patients with severe to very severe COPD with a history of exacerbation, while receiving Spiriva Handihaler (tiotropium bromide monohydrate) and a long-acting beta-agonist (LABA).

According to a post-hoc analysis, the use of ICS in addition to Spiriva Handihaler and LABA showed no additional benefit in lowering the risk of exacerbations vs. Spiriva Handihaler and LABA without ICS. It further showed patients who may benefit from ICS could easily be identified by measuring eosinophil levels in the blood. Specifically, researchers found patients with levels <4% (300 cells/mcL) were likely to have a lack of response to ICS. In this study, 20% of patients who benefited from continued ICS use on top of a combination of Spiriva Handihaler with LABA had raised levels of blood eosinophil (≥300 cells/µL; ≥4%).

“Long acting bronchodilators are a mainstay therapy in COPD management, however in clinical practice, ICS is widely used across all COPD stages,” said study investigator Peter Calverley, Professor of Pulmonary and Rehabilitation Medicine, University of Liverpool, UK. “Previously, it has been difficult to determine the subset of patients who respond to ICS. These findings will help physicians more confidently identify which patients may benefit from ICS therapy, helping minimize exposure to the risk of long-term side effects of ICS use.”

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Currently, ICS-containing therapy is recommended for use only in COPD patients with severe to very severe lung function impairment and/or at high risk of exacerbations, which reflected the patient group studied in WISDOM. However, only a small proportion of patients in the study saw a benefit with adding ICS to their treatment regimen.

More studies are needed to confirm these findings. No association was seen between blood eosinophil count and change in lung function with ICS withdrawal, study authors concluded.

Spiriva Handihaler is indicated as long-term maintenance treatment of bronchospasm due to COPD, including chronic bronchitis and emphysema, and to reduce exacerbations of COPD.

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