Point of care blood eosinophil guided oral prednisolone for COPD exacerbations: a multi-centre double blind randomised controlled trial (The STARR2 trial)

Abstract

Introduction and Objectives: Prednisolone for COPD exacerbation treatment leads to more patient harm than benefit. We aimed to evaluate the efficacy of blood-eosinophil directed corticosteroid therapy using near-patient testing, compared to current standard practice during an exacerbation of COPD in a multi-centre primary care study.

Methods: Patients with a COPD exacerbations were recruited from 14 general practices in Oxfordshire and Buckinghamshirethe Thames Valley. Participants were randomly allocated to receive intervention with eosinophil-biomarker guided matched prednisolone or placebo or standard care (matched prednisolone 30mg) for 14 days. Participants in the intervention arm with a blood eosinophil count of <2% on point of care testing were treated with blinded placebo. The primary outcome was the rate of treatment failure, defined as any need for antibiotics and/or steroids at 30 days.

Results: 203 exacerbations were randomised to eosinophil-biomarker guided (n=102) or standard care (n=101) for management of the exacerbation. The mean age (range) was 71 (46 to 90). One third of exacerbations (n=34) in the eosinophil-biomarker guided were treated with placebo. Intention to treat analysis at day 30 showed that treatment failure occurred in 28 and 34 patients in the eosinophil-biomarker guided and standard care arms respectively (RR 0.82 95% CI 0.54 – 1.23, p=0.34).

Conclusion: Reduction of prednisolone therapy, using near-patient testing can be safely performed using an eosinophil-biomarker guided approach in primary care for treatment of an exacerbation of COPD.