Pneumologie 2019; 73(S 01)
DOI: 10.1055/s-0039-1678008
Posterbegehung (P01) – Sektion Klinische Pneumologie
COPD im Wandel
Georg Thieme Verlag KG Stuttgart · New York

Blood eosinophil counts and treatment response in COPD: analyses of IMPACT

S Pascoe
1   Glaxosmithkline
,
N Barnes
1   Glaxosmithkline
,
G Brusselle
2   Ghent University Hospital
,
C Compton
1   Glaxosmithkline
,
G Criner
3   Lewis Katz School of Medicine at Temple University
,
M Dransfield
4   Division of Pulmonary, Allergy, and Critical Care Medicie, Lung Health Center, University Alabama at Birmingham
,
DMG Halpin
5   Department of Respiratory Medicine, Royal Devon and Exeter Hospital
,
MK Han
6   University of Michigan, Pulmonary and Critical Care
,
B Hartley
7   Statistics and Programming, Veramed Ltd
,
E Hilton
1   Glaxosmithkline
,
P Lange
8   University of Copenhagen
,
S Lettis
7   Statistics and Programming, Veramed Ltd
,
DA Lipson
9   Glaxosmithkline, Perelman School of Medicine, University of Pennsylvania
,
DA Lomas
10   Ucl Respiratory, University College London
,
FJ Martinez
11   New York-Presbyterian Hospital, Weill Cornell Medical Center
,
A Papi
12   Research Centre on Asthma and Copd, Department of Medical Science, University of Ferrara
,
N Roche
13   Cochin Hospital Ap-Hp, University Paris Descartes
,
RJP van der Valk
1   Glaxosmithkline
,
R Wise
14   Division of Pulmonary, Allergy, and Critical Care Medicine, Johns Hopkins Medicine
,
D Singh
15   University of Manchester
› Author Affiliations
Further Information

Publication History

Publication Date:
19 February 2019 (online)

Also available at
 

The abstract will be presented as an ENCORE by Dr. Marcel Reeh on behalf of the authors with their permissions. It was presented at ERS 2018 in Paris.

Background IMPACT is a landmark > 10,000 patient study that simplifies patient care in COPD and prospectively identifies phenotypes/endotypes associated with preferential response to inhaled maintenance treatments. Previous studies have shown a relation between ICS-associated reduction in the rate of acute exacerbation of COPD (AECOPD) and baseline blood eosinophil count (BEC).

Methods IMPACT is a randomised, double-blind, parallel-group, 52-week, global study comparing once-daily fluticasone furoate(FF)/umeclidinium(UMEC)/vilanterol(VI) to components FF/VI and UMEC/VI. Eligible patients had moderate to severe COPD and experienced ≥ 1 moderate/severe AECOPD in the past 12 months. We used negative binomial regression with fractional polynomials for modelling of continuous BEC, to model the number of moderate/severe AECOPD, comparing subjects in the 3 treatment groups.

Results The magnitude of benefit of ICS containing arms (FF/UMEC/VI [N = 4,151] and FF/VI [N = 4,134]) compared to non-ICS (UMEC/VI [N = 2,070]) in reducing the rate of moderate/severe AECOPD increased in proportion to BEC ([Fig. 1]).

Zoom Image
Modeled data showing relationship between BEC and rate of moderate/severe exacerbations by treatment, point estimates show data fitted in quintiles.

Conclusions In exacerbating COPD patients treated with UMEC/VI but not in those receiving FF (ICS), exacerbation rate increases with increasing BEC. Baseline BEC is linked with FF-associated exacerbation reduction on a continuous scale. This analysis prospectively confirms the value of BEC in the management of COPD.

Funding GSK (CTT116855; NCT02164513)