https://doi.org/10.55788/f96167d1
“Corticosteroids are known to increase harm in our patients,” said Prof. Mona Bafadhel (King’s College London, UK) [1]. Evidence suggests that eosinophil-directed oral corticosteroid (OCS) treatment is non-inferior to standard-of-care OCS [2,3]. The multicentre, double-blind, randomised, placebo-controlled STARR2 trial (NCT04458636) aimed to confirm these results [1]. Patients with COPD (n=203) were randomised to standard-of-care OCS or blood-eosinophil-directed OCS in the treatment of exacerbations. In the experimental condition, participants received a placebo if their eosinophil count was <2% and prednisolone if eosinophil count was ≥2%. The primary outcome was treatment failure at day 30.
In the intention-to-treat analysis, eosinophil-directed care was non-inferior to standard-of-care (RR 0.82; 95% CI 0.54–1.23; P=0.34), with 27% and 34% of failed treatments in the experimental arm and the control arm, respectively. The per-protocol analysis confirmed the non-inferiority of the experimental treatment compared with the control arm in terms of treatment failure (19% vs 32%; RR 0.60; 95% CI 0.33–1.04; P=0.07). In addition, forced expiratory volume in 1 second (FEV1) results, COPD Assessment Test (CAT) scores, and Visual Analogue Score (VAS) symptom scores did not display significant differences between the 2 treatment arms.
This large, primary care, COPD study showed that point-of-care eosinophil-guided prescription of OCS is safe and not associated with worse outcomes than standard-of-care prescription of OCS, concluded Prof. Bafadhel. “This new approach should be implemented in the guidelines, because it offers a more precise treatment and may reduce harmful events in our patients.”
- Bafadhel M, et al. Point of care blood eosinophil guided oral prednisolone for COPD exacerbations: a multi-centre double blind randomised controlled trial (The STARR2 trial). ALERT 1, RCT711, ERS International Congress 2022, Barcelona, Spain, 4–6 September.
- Bafadhel, M, et al. Am J Respir Crit Care Med. 2012;186(1):48–55.
- Sivapalan P, et al. BMJ Open Respir Res. 2019;6(1):e000407.
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