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首页> 外文期刊>Current drug targets-The International journal for timely in-depth reviews on drug targets >Absolute Blood Eosinophil Counts to Guide Inhaled Corticosteroids Therapy Among Patients with COPD: Systematic Review and Meta-analysis
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Absolute Blood Eosinophil Counts to Guide Inhaled Corticosteroids Therapy Among Patients with COPD: Systematic Review and Meta-analysis

机译：绝对血嗜酸性粒细胞计数，以指导COPD患者吸入的皮质类固醇治疗：系统审查和荟萃分析

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Introduction: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019recommends the use of absolute blood eosinophil count as a guide for the escalation and de-escalationof inhaled corticosteroids (ICS) in the pharmacological management of patients with chronic obstructivepulmonary disease (COPD). We evaluated the risk of moderate or severe exacerbations amongpatients escalating and de-escalating ICS therapy by absolute blood eosinophil thresholds in this systematicreview.Methods: Through a comprehensive literature search of Pubmed/MEDLINE, EMBASE, and clinicaltrial sites up to April 2019, we identified relevant studies. We used generic inverse variance methodwith fixed-effects estimates to compare the risk of moderate or severe exacerbations among COPD patientswith elevated blood eosinophil counts exposed to inhaled corticosteroids (ICS) versus non-ICStreatments groups expressed as risk ratios.Results: Ten studies (8 randomised control trials and 2 observational studies) were included, with atotal of 85,059 COPD patients. In our pooled analysis, we found an overall reduction in risk of moderateor severe exacerbations in patients with absolute blood eosinophil thresholds ranging from ≥ 100to ≥ 340 cells/μL among patients escalating ICS (RR, 0.77, 95% CI, 0.73-0.81). For studies evaluatingthe effects of de-escalation of ICS on moderate to severe exacerbations using blood eosinophil thresholdsof ≥ 300 to ≥ 340 cells/μL had an increased risk of moderate or severe exacerbations followingthe de-escalation of ICS (RR, 1.66, 95% CI, 1.31-2.10).Conclusion: This study confirms the validity of the recommended absolute blood eosinophil countthresholds for the escalation and de-escalation of ICS among COPD patients. However, this recommendationis for COPD patients with prior exacerbations rather than among newly diagnosed COPDpatients as observed in this study. COPD patients with current or past history of asthma represent aunique phenotypic group which should be further evaluated.
机译：简介：2019年慢性阻塞性肺病（黄金）的全球倡议是使用绝对血液粒细胞计数作为慢性障碍肺炎患者药理学管理中吸入的皮质类固醇（ICS）的升级和去升级的指南。我们评估了在该Systematicreview中的绝对血液粒细胞阈值升级和脱升升级的ICS治疗的中度或严重恶化的风险。相关研究。我们使用了仿制效应估计来比较COPD患者中温和或严重恶化的风险的升高，血液粒细胞计数与吸入的皮质类固醇（ICS）与非ICStreations组成为风险比率。结果：十项研究（8种随机包括控制试验和2项观察研究），具有85,059名COPD患者的Atotal。在我们的汇集分析中，我们发现，绝对血液粒细胞阈值的患者中度患者的患者风险的总体降低了≥100至≥340细胞/μl的患者，患者升级ICS（RR，0.77,95％CI，0.73-0.81）。对于研究评估ICS脱升升级对使用血液嗜酸性粒细胞阈值/μl的血液嗜酸性粒细胞阈值/μL的效果，≥30℃/μL的风险增加（RR，1.66,95％CI ，1.31-2.10）。结论：本研究证实了推荐的绝对血液粒细胞计数的有效性，用于COPD患者中IC的升级和脱升升级。然而，这项建议对于COPD患者的患者，而不是本研究中观察到的新诊断的胁迫剂。 COPD患有哮喘的哮喘或过去历史的患者代表了应进一步评估的Aunique表型组。

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