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Article

Corticosteroid Resistance in Smokers—A Substudy Analysis of the CORTICO-COP Randomised Controlled Trial

1
Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
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Department of Internal Medicine, Zealand University Hospital, 4000 Roskilde, Denmark
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Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
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Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester M13 9NT, UK
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Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Denmark and Institute of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Department of Respiratory Medicine, Antwerp University Hospital and Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, 2000 Antwerp, Belgium
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The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
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Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
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Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
*
Author to whom correspondence should be addressed.
Academic Editors: Jose Luis Lopez-Campos and Swati Bhattacharyya
J. Clin. Med. 2021, 10(12), 2734; https://doi.org/10.3390/jcm10122734
Received: 5 May 2021 / Revised: 8 June 2021 / Accepted: 16 June 2021 / Published: 21 June 2021
The CORTICO-COP trial showed that eosinophil-guided corticosteroid-sparing treatment for acute exacerbation of chronic obstructive pulmonary disease was non-inferior to standard of care and decreased the accumulated dose of systemic corticosteroids that patients were exposed to by approximately 60%. Smoking status has been shown to affect corticosteroid responsiveness. This post hoc analysis investigated whether eosinophil-guided treatment is non-inferior to conventional treatment in current smokers. The main analysis of current smokers showed no significant difference in the primary endpoint, days alive, and out of hospital within 14 days between the control group (mean, 9.8 days; 95% confidence interval (CI), 8.7–10.8) and the eosinophil-guided group (mean, 8.7 days; 95% CI, 7.5–9.9; p = 0.34). Secondary analyses of the number of exacerbations or deaths, the number of intensive care unit admissions or deaths, lung function improvement, and change in health-related quality of life also showed no significant differences between the two groups. The results of a sensitivity analysis of ex-smokers are consistent with the main analysis. Our results suggest that eosinophil-guided treatment is non-inferior to standard of care in current smokers and ex-smokers. Because data on the impact of smoking status on eosinophil-guided treatments are sparse, more randomised trials are needed to confirm our results. View Full-Text
Keywords: chronic obstructive pulmonary disease; corticosteroid resistance; smoking; airway inflammation; blood eosinophils chronic obstructive pulmonary disease; corticosteroid resistance; smoking; airway inflammation; blood eosinophils
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MDPI and ACS Style

Sivapalan, P.; Bikov, A.; Suppli Ulrik, C.; Lapperre, T.S.; Mathioudakis, A.G.; Højberg Lassen, M.C.; Grundtvig Skaarup, K.; Biering-Sørensen, T.; Vestbo, J.; Jensen, J.-U.S. Corticosteroid Resistance in Smokers—A Substudy Analysis of the CORTICO-COP Randomised Controlled Trial. J. Clin. Med. 2021, 10, 2734. https://doi.org/10.3390/jcm10122734

AMA Style

Sivapalan P, Bikov A, Suppli Ulrik C, Lapperre TS, Mathioudakis AG, Højberg Lassen MC, Grundtvig Skaarup K, Biering-Sørensen T, Vestbo J, Jensen J-US. Corticosteroid Resistance in Smokers—A Substudy Analysis of the CORTICO-COP Randomised Controlled Trial. Journal of Clinical Medicine. 2021; 10(12):2734. https://doi.org/10.3390/jcm10122734

Chicago/Turabian Style

Sivapalan, Pradeesh, Andras Bikov, Charlotte Suppli Ulrik, Therese S. Lapperre, Alexander G. Mathioudakis, Mats C. Højberg Lassen, Kristoffer Grundtvig Skaarup, Tor Biering-Sørensen, Jørgen Vestbo, and Jens-Ulrik S. Jensen 2021. "Corticosteroid Resistance in Smokers—A Substudy Analysis of the CORTICO-COP Randomised Controlled Trial" Journal of Clinical Medicine 10, no. 12: 2734. https://doi.org/10.3390/jcm10122734

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