Treatment Efficacy of Systemic Corticosteroids in AECOPD Patients With Higher Blood Eosinophil Levels
Study Details
Study Description
Brief Summary
Chronic Obstructive Pulmonary Disease (COPD) is one of the top three causes of death worldwide now. Acute exacerbations (AEs) of COPD are a risk factor for lung function deterioration, poor quality of life, longer hospitalization, and increased mortality. To date, COPD is associated with a heavy clinical and socioeconomic burden, of which AEs of COPD account for a significant part of the cost of patients with COPD. Although several retrospective cohort studies and post-hoc analyses from randomized controlled trials (RCTs) showed that AECOPD patients with higher blood eosinophils had a shorter length of hospital stay (LOS), lower doses of corticosteroid use, and better response to systematic corticosteroid treatment than those with lower blood eosinophils, the efficacy of systematic corticosteroids in AECOPD patients with higher blood eosinophils has not been confirmed by RCTs. Therefore, this study aims to evaluate if AECOPD patients admitted to hospitals with higher blood eosinophil levels could benefit from systemic corticosteroid therapy. In this study, all eligible AECOPD participants with peripheral blood eosinophil blood count >2% or > 300 cells/μL will be randomly assigned (1:1) to either a control group or a systemic corticosteroid group. The control group will receive an oral placebo of 40mg/day for five consecutive days in addition to standard treatment during emergency admission or hospitalization. And systemic corticosteroid group will receive oral prednisone 40mg/day for five consecutive days and standard treatment. This study will provide evidence on using peripheral blood eosinophil blood count to guide corticosteroid therapy in AECOPD patients and help the clinician make an individual decision for each patient.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 4 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Systemic corticosteroid group Patients will receive Oral prednisone 40mg/day for five consecutive days in addition to standard treatment during emergency admission or hospitalization. |
Drug: Prednisone
Oral prednisone 40mg/day for five consecutive days
|
Placebo Comparator: Control group Participating patients will receive an oral placebo of 40mg/day for five consecutive days in addition to standard treatment. |
Drug: Placebo
Oral placebo of 40mg/day for five consecutive days
|
Outcome Measures
Primary Outcome Measures
- Treatment failure rates [30 days]
Collect during index hospitalization and within 30 days after discharge.
Secondary Outcome Measures
- Admission to ICU rates during index hospitalization [14 days]
Collect during index hospitalization.
- Requiring or receiving invasive or non-invasive MV rates during index hospitalization [14 days]
Collect during index hospitalization.
- All-cause mortality during index hospitalization and within 90 days after discharge [90 days]
Collect during index hospitalization and 90-day follow-up.
- The length of hospital stay during index hospitalization [14 days]
Collect during index hospitalization.
- Readmission rates of AECOPD at 30-day, 60-day, and 90-day follow-ups [90 days]
Collect during 90-day follow-up.
- Time to readmission of AECOPD within 90 days [90 days]
Collect during 90-day follow-up.
- Changes in FEV1 between index hospitalization and 90-day follow-up [90 days]
Collect during 90-day follow-up.
- Changes in the scores of EXAcerbations of Chronic pulmonary disease Tool between index hospitalization and 90-day follow-up [90 days]
Collect during 90-day follow-up. The minimum and maximum values are 0 and 100, respectively. Higher scores mean a worse outcome.
- Changes in the scores of St. George's Respiratory Questionnaire between index hospitalization and 90-day follow-up [90 days]
Collect during 90-day follow-up. The minimum and maximum values are 1 and 80, respectively. Higher scores mean a worse outcome.
- Changes in the scores of Hospital Anxiety and Depression Scale between index hospitalization and 90-day follow-up [90 days]
Collect during 90-day follow-up. The minimum and maximum values are 0 and 42, respectively. Higher scores mean a worse outcome.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Within 24 hours of admission;
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Aged between of 40 and 80 years old;
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Established clinical history of COPD with spirometry-verified COPD (defined as post-bronchodilator forced expiratory volume in one second (FEV1)/ forced vital capacity (FVC) ≤ 0.70);
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AECOPD diagnosis in accordance with the GOLD guideline (An acute worsening of respiratory symptoms that result in additional therapy)12;
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Current or former cigarette smokers (≥10 packs per year);
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Blood eosinophil count > 2% or >300 cells/μL tested within 24 hours of admission;
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Signed informed consent.
Exclusion Criteria:
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Admission due to other diseases (pneumonia, pneumothorax, pulmonary interstitial disease, active tuberculosis or bronchiectasis, ect);
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Regular use of glucocorticoid ≥3 months;
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Received prednisone ≥ 60 mg in the past three days (or equivalent doses of other corticosteroid);
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Allergic or intolerant to corticosteroid;
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Participating in or completed another drug trial within 90 days;
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Pregnancy or lactation;
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Severe COPD exacerbation requiring invasive mechanical ventilation (IMV) or transfer to ICU within 24 hours after emergency admission or hospitalization;
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With complications that may cause eosinophilia;
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Pulmonary embolism within the past two years;
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Myocardial infarction, uncontrollable congestive heart failure or arrhythmia within the past four weeks;
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Comorbidity that may influence the immune system;
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Malignant tumor;
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Neuromuscular disease affecting the respiratory system;
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Systemic fungal infection;
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Thoracotomy or bronchoscopic lung volume reduction surgery history;
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Adrenocortical insufficiency history;
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Diabetes mellitus with poor glycemic control;
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Uncontrollable severe psychiatric illnesses even with medication, cognitive impairment, and severe language difficulties;
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ALT ≥ 100U/L or AST ≥ 80U/L;
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Serum creatinine ≥ 162umol/L;
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Life expectancy of less than 30 days.
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Capital Medical University
- Peking University
- Guang'anmen Hospital of China Academy of Chinese Medical Sciences
- Xuanwu Hospital, Beijing
- Beijing Anzhen Hospital
- Beijing Tongren Hospital
- Beijing Luhe Hospital
- Emergency General Hospital
- Beijing Jishuitan Hospital
- Beijing Jingmei Group Hospital
- Beijing Shijingshan Hospital
- Bejing INFI-SAGACITY TECHNOLOGY CO., LTD
- Chinese People's Liberation Army of China General Hospital
Investigators
- Study Chair: Tong Zhaohui, PhD, Beijing Chao Yang Hospital
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
- Bafadhel M, Greening NJ, Harvey-Dunstan TC, Williams JE, Morgan MD, Brightling CE, Hussain SF, Pavord ID, Singh SJ, Steiner MC. Blood Eosinophils and Outcomes in Severe Hospitalized Exacerbations of COPD. Chest. 2016 Aug;150(2):320-8. doi: 10.1016/j.chest.2016.01.026. Epub 2016 Feb 3.
- Cui Y, Zhan Z, Zeng Z, Huang K, Liang C, Mao X, Zhang Y, Ren X, Yang T, Chen Y. Blood Eosinophils and Clinical Outcomes in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Propensity Score Matching Analysis of Real-World Data in China. Front Med (Lausanne). 2021 Jun 9;8:653777. doi: 10.3389/fmed.2021.653777. eCollection 2021.
- Duffy SP, Criner GJ. Chronic Obstructive Pulmonary Disease: Evaluation and Management. Med Clin North Am. 2019 May;103(3):453-461. doi: 10.1016/j.mcna.2018.12.005. Epub 2019 Mar 14. Review.
- Ko FWS, Chan KP, Ngai J, Ng SS, Yip WH, Ip A, Chan TO, Hui DSC. Blood eosinophil count as a predictor of hospital length of stay in COPD exacerbations. Respirology. 2020 Mar;25(3):259-266. doi: 10.1111/resp.13660. Epub 2019 Aug 6.
- Labaki WW, Rosenberg SR. Chronic Obstructive Pulmonary Disease. Ann Intern Med. 2020 Aug 4;173(3):ITC17-ITC32. doi: 10.7326/AITC202008040. Review.
- Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998 May;157(5 Pt 1):1418-22.
- Sivapalan P, Lapperre TS, Janner J, Laub RR, Moberg M, Bech CS, Eklöf J, Holm FS, Armbruster K, Sivapalan P, Mosbech C, Ali AKM, Seersholm N, Wilcke JT, Brøndum E, Sonne TP, Rønholt F, Andreassen HF, Ulrik CS, Vestbo J, Jensen JS. Eosinophil-guided corticosteroid therapy in patients admitted to hospital with COPD exacerbation (CORTICO-COP): a multicentre, randomised, controlled, open-label, non-inferiority trial. Lancet Respir Med. 2019 Aug;7(8):699-709. doi: 10.1016/S2213-2600(19)30176-6. Epub 2019 May 20.
- Wedzicha JA, Singh R, Mackay AJ. Acute COPD exacerbations. Clin Chest Med. 2014 Mar;35(1):157-63. doi: 10.1016/j.ccm.2013.11.001. Review.
- Z201100005520029