C-reactive protein as a biomarker of response to inhaled corticosteroids among patients with COPD.

Abstract

AIMS:

C-reactive protein (CRP) is an important biomarker in systemic inflammation in COPD; reports have suggested inhaled corticosteroids (ICS) attenuate CRP levels. We evaluated the risk of moderate-to-severe exacerbations, severe exacerbations and all-cause mortality among patients with COPD currently exposed to Inhaled corticosteroids (ICS) stratified by CRP levels compared to never ICS users with low CRP levels.

METHODS:

We included subjects age 40 or more who had a diagnosis of COPD from January 1, 2005 to January 31, 2014 from the UK Clinical Practice Research Datalink (CPRD). ICS exposure was determined time-dependently, as current, recent, past or never users. We evaluated the risk of moderate-to-severe exacerbations, severe exacerbations and all-cause mortality among ICS users stratified by CRP levels.

RESULTS:

17,722 subjects diagnosed with COPD met the inclusion criteria. Among current or never ICS with elevated CRP levels we found, no significantly reduced risk of moderate-to-severe or severe exacerbations. For patients currently exposed ICS with CRP levels ≥8 mg/L there was no reduced risk of moderate-to-severe exacerbations (adjusted hazard ratio [adj. HR] 0.99; 95% confidence interval [CI] 0.76-1.31) or severe exacerbations (adj.HR 1.52; 95% CI 0.71-3.27). However, we found an increased risk of all-cause mortality among COPD patients with CRP levels ≥8 mg/L irrespective of ICS exposure.

CONCLUSION:

We did not find a reduced risk of moderate and/or severe COPD exacerbations among COPD patients with varying CRP levels currently exposed to ICS. However, low-grade systemic inflammation was associated with all-cause mortality among COPD patients.

• Authors: Olorunfemi A Oshagbemi, Frits M E Franssen, Emiel F M Wouters, Anke H Maitland-van der Zee, Johanna H M Driessen, Anthonius de Boer, Frank de Vries
• Journal: Pulmonary pharmacology & therapeutics (Pulm Pharmacol Ther) Vol. 60 Pg. 101870 (02 2020) ISSN: 1522-9629 [Electronic] England
• PMID: 31785343 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Ltd. All rights reserved.

Chemical References

• Adrenal Cortex Hormones
• Biomarkers
• Bronchodilator Agents
• C-Reactive Protein

Topics

• Administration, Inhalation
• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Aged
• Aged, 80 and over
• Biomarkers
• Bronchodilator Agents (therapeutic use)
• C-Reactive Protein (metabolism)
• Female
• Humans
• Male
• Middle Aged
• Pulmonary Disease, Chronic Obstructive (drug therapy, mortality)
• Risk Factors
• Symptom Flare Up