Exacerbations and health care resource use among patients with COPD in relation to blood eosinophil counts
Received 13 November 2018
Accepted for publication 25 February 2019
Published 22 March 2019 Volume 2019:14 Pages 683—692
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Hana Müllerová,1 Beth Hahn,2 Edgar P Simard,3 George Mu,3 Umur Hatipoğlu4
1Real-World Evidence, GSK, Stockley Park, Uxbridge, Middlesex, UK; 2US Medical Affairs, GSK, Research Triangle Park, NC, USA; 3Real-World Data and Analytics, GSK, Upper Providence, PA, USA; 4Center for Comprehensive Care in Chronic Obstructive Pulmonary Disease, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
Purpose: Current understanding of the relationship between COPD phenotype and health care resource utilization (HCRU) is limited. This real-world study evaluated disease burden and HCRU for COPD subgroups prone to exacerbation as defined by blood eosinophil (EOS) count and multiple inhaler triple therapy (MITT) use.
Methods: This was a large-scale, retrospective, longitudinal, observational cohort study using data from the US IBM Watson Explorys real-world database (GSK Study HO-17-18395). The population of interest comprised patients with COPD ≥40 years of age with ≥2 moderate or ≥1 severe exacerbations (prior year) while on inhaled maintenance therapy, with ≥1 blood EOS count. Data were analyzed during the year prior to index date (last COPD encounter between January 1, 2011 and December 31, 2016). Four subgroups were analyzed based on a combination of EOS counts (<150 and ≥150 cells/μL) and MITT use (receiving or not receiving). Among these groups, clinical characteristics, exacerbations, and HCRU were described. A sensitivity analysis that further stratified EOS into four categories (<150, ≥150–<300, ≥300–<500, and ≥500 cells/μL) was also performed.
Results: The COPD population of interest comprised 34,268 patients. Subgroups with EOS ≥150 cells/µL vs ,150 cells/µL had more comorbidities and experienced significantly higher mean numbers of moderate exacerbations (not receiving MITT, ≥150 cells/µL vs <150 cells/µL: 1.93 vs 1.82, P<0.0001; receiving MITT 2.26 vs 2.16, P=0.0062) and COPDrelated emergency visits (not receiving MITT, ≥150 cells/µL vs <150 cells/µL: 3.0 vs 2.5, P<0.001; receiving MITT 3.4 vs 3.1, P=0.0011). Increasing EOS category was associated with higher HCRU.
Conclusion: Blood EOS ≥150/µL cells were associated with increased HCRU and higher exacerbation rates compared with EOS <150 cells/μL, irrespective of MITT use. COPD phenotyping using blood EOS could help identify candidates for additional therapies that target
eosinophilic inflammatory pathways.
Keywords: COPD, eosinophil, exacerbation, health care resource, phenotype
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