Anti-IL5/IL5R Treatment in COPD: Should We Target Oral Corticosteroid-Dependent Patients?

Figures & data

Table 1 Participants Characteristics at Baseline (V₀)

	Total Cases (N = 7)	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6	Case 7
Age — years	64.0 ± 5.1	69	68	60	58	68	58	67
Sex	5M:2F	Male	Female	Female	Male	Male	Male	Male
Smoking history		Former	Former	Active	Former	Never*	Former	Former
Number of pack-years	32.5 ± 15.4	20	25	40	60	N/A	20	30
Age of COPD diagnosis — years	56.1 ± 5.7	54	64	50	51	60	52	62
COPD Phenotype
Emphysema	7 (100)	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Chronic bronchitis	2 (29)	No	No	No	Yes	No	Yes	No
Number of exacerbations in previous year
Total	7.3 ± 3.9	7	1	9	8	9	4	13
Hospitalizations	1.0 ± 1.4	1	1	1	0	4	0	0
Comorbidities
Asthma diagnosis before 40 years of age	1 (14)	No	No	No	No	No	Yes	No
Bronchiectasis	6 (86)	Yes	Yes	Yes	Yes	Yes	Yes	No
Oral corticosteroids dose — mg/day	11.4 ± 6.9	10.0	15.0	5.0	10.0	10.0	5.0	25.0
Skin prick tests	3 (50)	N/A	Positive	Negative	Positive	Positive	Negative	Negative
Total serum IgE — IU/mL	78.5 ± 53.6	22.0	14.0	106.0	148.0	34.2	113.0	112.0
Blood eosinophils — X10^6 cells/L	237 ± 225	600	N/A	100	220	0	100	400
Sputum eosinophils — %	49.7 ± 11.1	N/A	N/A	N/A	N/A	N/A	41.8	57.5
FEV1 — liters	0.98 ± 0.29	1.44	1.06	0.68	0.92	1.11	0.56	1.08
FEV1 — % of predicted value post-bronchodilator	34.6 ± 13.2	48.3	53.8	25.8	26.0	37.8	16.5	34.1
Historical data
Maximal recorded blood eosinophils — X10^6 cells/L	729 ± 315	600	800	300	800	1100	1100	400
Maximal recorded sputum eosinophils — %	54.3 ± 4.6	N/A	N/A	N/A	N/A	N/A	51.0	57.5
Maximal recorded reversibility — liters	0.17 ± 0.09	0.11	0.16	N/A	0.29	0.11	0.10	0.26
Maximal recorded reversibility — % change	16.5 ± 10.3	7.9	15.0	N/A	35.0	7.0	14.0	20.0

Notes: Plus–minus values are means ±SD. *This patient was diagnosed with a genetic form of COPD based on the presence of severe and progressive emphysema without relevant exposure/history.

Abbreviations: N/A, Unavailable or not applicable; COPD, chronic obstructive pulmonary disease; IU, international unit; FEV₁, forced expiratory volume in one second; L, liter.

Table 2 Post-Treatment Outcomes (V₁)

	Total Cases (N = 7)	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6	Case 7
	Biological Agent	Mepo	Benra	Mepo	Benra	Mepo	Benra	Mepo
Oral corticosteroids dose — mg/day	2.6 ± 3.8	0	5*	0*	10	0	3	0
Number of exacerbations on biologic
Total	0.7 ± 1.1	1	0*	0*	3	0	0	1
Hospitalizations	0.1 ± 0.4	0	0*	0*	1	0	0	0
Blood eosinophils — X10^6 cells/L	16.7 ± 40.8	0	0*	100*	0	0	0	N/A
Sputum eosinophils — %	1.0 ± 1.4	0	N/A*	2.0*	N/A	N/A	N/A	N/A
FEV1 — liters	1.0 ± 0.3	1.43	1.05*	0.70*	0.96	1.05	0.57	1.33
FEV1 — % of predicted value post-bronchodilator	36.5 ± 13.0	49.8	53.3*	26.8*	30.0	36.1	16.9	42.5

Notes: Plus–minus values are means ±SD. *Post-treatment outcomes for cases 2 and 3 were collected respectively at 5 and 6 months (time of the last visit available) after the initiation of the biologic.

Abbreviations: N/A, Unavailable or not applicable; Mepo, Mepolizumab; Benra, Benralizumab; IU, international unit; FEV₁, forced expiratory volume in one second; L, liter.

Figure 1 Daily oral corticosteroids intake.

Notes: Cases that had not completed 12 months of anti-IL5/5R treatment at the time of data collection are represented by grey lines. Oral corticosteroids intake for cases 2 and 3 were collected respectively at 5 and 6 months (time of the last visit available) after the initiation of the biologic.

Abbreviation: OCS, oral corticosteroids.

Figure 2 Annual exacerbation rate.

Notes: Cases that had not completed 12 months of anti-IL5/5R treatment at the time of data collection are represented by grey lines. Annual exacerbation rate for cases 2 and 3 were collected respectively at 5 and 6 months (time of the last visit available) after the initiation of the biologic.

Figure 3 Blood eosinophils levels.

Notes: Historical blood eosinophil level was measured in the last 3 years before baseline visit (V₀). Cases that had not completed 12 months of anti-IL5/5R treatment at the time of data collection are represented by grey lines. Blood eosinophil levels for cases 2 and 3 were collected respectively at 5 and 6 months (time of the last visit available) after the initiation of the biologic.