Point-of-care eosinophil-guided prednisolone for COPD exacerbations safe: STARR2 trial

Personalized point-of-care eosinophil-guided oral prednisolone therapy in primary care was safe and did not worsen outcomes in individuals with COPD exacerbations, researchers reported at the European Respiratory Society International Congress.

“This is the largest primary care multicenter trial of its kind, and probably adds to another 20% of the current literature base for exacerbations in COPD,” Mona Bafadhel, MBChB, PhD, FRCP, researcher and associate professor of respiratory medicine and consultant respiratory physician in the Nuffield Department of Medicine at Oxford University, London, said during a presentation. “The reduction of oral corticosteroids is likely to [have an] impact on extended outcomes of COPD ... and a personalized endotype-based treatment with oral prednisone is possible in patients who have COPD, and I think should be now part of clinical guidelines.”

Researchers conducted STARR2, a multicenter, double-blind, randomized placebo-controlled trial of 152 patients with COPD exacerbations who visited primary care practices in the United Kingdom. The researchers’ aim was to evaluate eosinophil-guided prednisolone therapy using near-patient testing compared with standard care during a COPD exacerbation in a multicenter primary care study.

Patients were randomly assigned to receive eosinophil-guided care (n = 76; mean age, 70 years; 58% men) or standard care (n = 76; mean age, 70 years; 61% men). In the eosinophil-guided care group, patients received prednisolone if they had a blood eosinophil count greater than 2% or received blinded placebo if their count was below 2%. Patients in the standard care group received prednisolone regardless of eosinophil count.

The primary outcome was treatment failure, which researchers defined as need for antibiotics and/or steroids within 30 days.

The total number of COPD exacerbations was 203: 102 randomized to the eosinophil-guided care arm and 101 to the standard care arm. Researchers observed no difference in treatment failure between the eosinophil-guided care and standard care groups (proportion of treatment failure at day 28: 27% vs. 34%; RR = 0.82; 95% CI, 0.54-1.23; P = .34).

In addition, results showed no differences in FEV₁ (P = .53), COPD Assessment Test (CAT) symptom scores (P = .6) and symptom visual analogue scale (P = .71) at 30 days.