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首页> 外文期刊>Respiratory Research >Blood eosinophil count, a marker of inhaled corticosteroid effectiveness in preventing COPD exacerbations in post-hoc RCT and observational studies: systematic review and meta-analysis
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Blood eosinophil count, a marker of inhaled corticosteroid effectiveness in preventing COPD exacerbations in post-hoc RCT and observational studies: systematic review and meta-analysis

机译：血嗜酸性粒细胞计数，一种吸入皮质类固醇效应的标志物，防止HOC后rct和观察研究中的COCD加剧：系统评价和荟萃分析

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BackgroundBlood eosinophil count has been proposed as a predictor of response to inhaled corticosteroid (ICS) in the prevention of acute exacerbations of COPD. An optimal threshold of blood eosinophil count for prescribing ICS has not been agreed. Doubt has been cast on the role by observational studies. The role of inhaled corticosteroids in this relationship, independent of long-acting bronchodilators, has not been examined.MethodsWe conducted a systematic review of post-hoc analyses of randomised controlled trials (RCTs) and observational studies examining three blood eosinophil thresholds and the independent role of ICS. Included studies were categorised by the form (relative or absolute count) and cut point of eosinophil threshold used. Thresholds assessed were relative eosinophil count of 2%, and absolute counts of 150 cells/μL and 300 cells/μL. Three meta-analyses of the effect of ICS use in post-hoc analyses of RCTs based on these counts were carried out. Initial analysis included all studies of ICS vs. any non-ICS regimen. Further analysis examined the effect of ICS, independent of the effect of long-acting bronchodilators.ResultsSixteen studies examined the association between blood eosinophil count and response of exacerbation risk to ICS, in COPD patients. Eleven studies (25,881 patients) were post-hoc analyses of RCTs. Five studies (109,704 patients) were retrospective observational studies. The independent effect of ICS on the reduction of exacerbation risk was 20% at ≥2% blood eosinophil threshold (RR, 0.80; 95% CI, 0.74–0.85), 35% at ≥150 cells/μL blood eosinophil threshold (RR, 0.65; 0.52–0.79), and 39% at ≥300 cells/μL blood eosinophil threshold (RR, 0.61; 0.44–0.78). No association was found in four out of five observational studies.ConclusionThis is the first systematic review to assess, in post-hoc analyses of RCTs, the independent effect of ICS in reducing the risk of COPD exacerbation across a range of blood eosinophil thresholds. Association between ICS prescription and reduced exacerbation risk at these thresholds was confirmed. The lack of association found in the observational studies questions the relevance of these observations to a “real world” COPD population. To clarify the clinical utility of this biomarker, the association should be tested in prospective effectiveness studies.
机译：背景包括嗜酸性粒细胞计数已被提出为对吸入皮质类固醇（IC）预防COPD急性加剧的反应的预测因子。没有达成一定关于规定IC的血液嗜酸性粒细胞计数的最佳阈值。怀疑是通过观察研究的作用。吸入皮质类固醇在这种关系中的作用，独立于长效的支气管扩张剂，尚未研究。乙其合一对随机对照试验（RCT）的后HOC分析进行了系统审查，以及检查三种血液梭阈值和独立作用的观察研究IC。通过使用的形式（相对或绝对计数）和嗜酸性粒细胞阈值的切割点分类包括的研究。评估的阈值为2％的相对嗜酸性粒细胞计数，以及150个细胞/μl和300个细胞/μl的绝对计数。进行了基于这些计数的RCT后HOC诊断效应的三种荟萃分析。初步分析包括所有对IC的研究与任何非ICS方案。进一步的分析检测了IC的效果，与长效的支气管扩张剂的效果无关。结果司令纪研究检测了血嗜酸性粒细胞计数与ICS对IC的抗癌风险的关系，在COPD患者中。 11项研究（25,881名患者）是RCT的后HOC分析。五项研究（109,704名患者）是回顾性观察研究。 IC对血液嗜酸性粒细胞阈值≥2％≥2％≥2％≥2％的影响的独立效果为20％（RR，0.80; 95％CI，0.74-0.85），35％，≥150个细胞/μL血液粒细胞阈值（RR，0.65 ; 0.52-0.79），≥300个细胞/μl血液粒细胞阈值（RR，0.61; 0.44-0.78），39％。在五种观察研究中有四项中未发现任何关联.Conclusionthis是评估RCT后HOC分析的第一次系统审查，IC在降低一系列血液粒细胞阈值方面降低COPD加剧风险的独立效应。确认了这些阈值的ICS处方和降低的恶化风险之间的关系。在观察研究中发现的缺乏关联质疑这些观察结果与“现实世界”的COPD人口的相关性。为了澄清这种生物标志物的临床效用，应在前瞻性效果研究中进行关联。

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