Late Breaking Abstract - Blood eosinophil counts and treatment response in COPD: analyses of IMPACT

Background: IMPACT is a landmark u003e10,000 patient study that simplifies patient care in COPD and prospectively identifies phenotypes/endotypes associated with preferential response to inhaled maintenance treatments. Previous studies have shown a relation between ICS-associated reduction in the rate of acute exacerbation of COPD (AECOPD) and baseline blood eosinophil count (BEC). Methods: IMPACT is a randomised, double-blind, parallel-group, 52-week, global study comparing once-daily fluticasone furoate(FF)/umeclidinium(UMEC)/vilanterol(VI) to components FF/VI and UMEC/VI. Eligible patients had moderate to severe COPD and experienced ≥1 moderate/severe AECOPD in the past 12 months. We used negative binomial regression with fractional polynomials for modelling of continuous BEC, to model the number of moderate/severe AECOPD, comparing subjects in the 3 treatment groups. Results: The magnitude of benefit of ICS containing arms (FF/UMEC/VI [N=4,151] and FF/VI [N=4,134]) compared to non-ICS (UMEC/VI [N=2,070]) in reducing the rate of moderate/severe AECOPD increased in proportion to BEC (Fig 1). Conclusions: In exacerbating COPD patients treated with UMEC/VI but not in those receiving FF (ICS), exacerbation rate increases with increasing BEC. Baseline BEC is linked with FF-associated exacerbation reduction on a continuous scale. This analysis prospectively confirms the value of BEC in the management of COPD.