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Meta-Analysis
. 2018 Sep 6:13:2775-2784.
doi: 10.2147/COPD.S175017. eCollection 2018.

Blood eosinophils and inhaled corticosteroids in patients with COPD: systematic review and meta-analysis

Shih-Lung Cheng  1   2
Affiliations
Meta-Analysis

Blood eosinophils and inhaled corticosteroids in patients with COPD: systematic review and meta-analysis

Shih-Lung Cheng. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: COPD is a highly heterogeneous disease. Potential biomarkers to identify patients with COPD who will derive the greatest benefit from inhaled corticosteroid (ICS) treatment are needed. Blood eosinophil count can serve as a predictive biomarker for the efficacy of ICS treatment. The aim of this systematic review and meta-analysis was to assess whether a blood eosinophil count of ≥2% in patients undergoing ICS therapy was associated with a greater reduction in COPD exacerbation rate and pneumonia incidence.

Materials and methods: An electronic search was performed using the keywords "COPD", "eosinophil", and "clinical trial" in the PubMed and EMBASE databases to retrieve articles, up to 2017, relevant to our focus. Data were extracted, and a meta-analysis was conducted using RevMan 5 (version 5.3.5).

Results: Five studies comprising 12,496 patients with moderate-to-very severe COPD were included. At baseline, 60% of the patients had ≥2% blood eosinophils. Our meta-analysis showed a 17% reduction in exacerbation of moderate/severe COPD in patients with ≥2% blood eosinophils undergoing ICS therapy compared to the non-ICS/ICS withdrawal/placebo group. The difference between the two types of treatment was significant (risk ratio [RR], 0.816; 95% CI, 0.67-0.99; P=0.03). Furthermore, the risk of pneumonia-related events was significantly increased in the subgroup with eosinophil count ≥2% undergoing ICS-containing treatments (RR, 1.969; 95% CI, 1.369-2.833; P<0.001). There was no significant difference in the subgroup with eosinophil count <2% (RR, 1.29; 95% CI, 0.888-1.879; P<0.181).

Conclusion: The results of our meta-analysis suggest that the 2% threshold for blood eosinophils could accurately predict ICS treatment response in patients with COPD, but increased the risk of pneumonia.

Keywords: COPD; eosinophil; inhaled corticosteroid.

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Conflict of interest statement

Disclosure The author reports no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Forest plots of studies comparing the pooled risk ratio for moderate/severe exacerbation in patients with COPD receiving ICS-containing treatment or non-ICS/ICS withdrawal/placebo treatments by subgroup. Note: (A) Eosinophil counts <2% and (B) eosinophil counts ≥2%. Abbreviation: ICS, inhaled corticosteroid.
Figure 2
Figure 2
Analysis of publication bias for pooled risk ratio of moderate/severe exacerbation for (A) eosinophil counts <2% and (B) eosinophil counts ≥2%.
Figure 3
Figure 3
Forest plots of studies comparing the pooled hazard ratio for time-to-first moderate/severe exacerbation in patients with COPD receiving ICS-containing treatment or non-ICS/ICS withdrawal/placebo treatments by subgroup. Note: (A) Eosinophil counts <2% and (B) eosinophil counts ≥2%. Abbreviation: ICS, inhaled corticosteroid.
Figure 4
Figure 4
Forest plots of studies comparing the pooled relative risk of pneumonia events in patients with COPD receiving ICS-containing treatment or non-ICS/ICS withdrawal/placebo treatments by subgroup. Note: (A) Eosinophil counts <2% and (B) eosinophil counts ≥2%. Abbreviation: ICS, inhaled corticosteroid.
See this image and copyright information in PMC

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