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Vermeersch K, Belmans A, Bogaerts K, Gyselinck I, Cardinaels N, Gabrovska M, Aumann J, Demedts IK, Corhay JL, Marchand E, Slabbynck H, Haenebalcke C, Vermeersch S, Verleden GM, Troosters T, Ninane V, Brusselle GG, Janssens W. Treatment failure and hospital readmissions in severe COPD exacerbations treated with azithromycin versus placebo - a post-hoc analysis of the BACE randomized controlled trial. Respir Res 2019; 20:237. [PMID: 31665017 PMCID: PMC6819655 DOI: 10.1186/s12931-019-1208-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/09/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In the BACE trial, a 3-month (3 m) intervention with azithromycin, initiated at the onset of an infectious COPD exacerbation requiring hospitalization, decreased the rate of a first treatment failure (TF); the composite of treatment intensification (TI), step-up in hospital care (SH) and mortality. OBJECTIVES (1) To investigate the intervention's effect on recurrent events, and (2) to identify clinical subgroups most likely to benefit, determined from the incidence rate of TF and hospital readmissions. METHODS Enrolment criteria included the diagnosis of COPD, a smoking history of ≥10 pack-years and ≥ 1 exacerbation in the previous year. Rate ratio (RR) calculations, subgroup analyses and modelling of continuous variables using splines were based on a Poisson regression model, adjusted for exposure time. RESULTS Azithromycin significantly reduced TF by 24% within 3 m (RR = 0.76, 95%CI:0.59;0.97, p = 0.031) through a 50% reduction in SH (RR = 0.50, 95%CI:0.30;0.81, p = 0.006), which comprised of a 53% reduction in hospital readmissions (RR = 0.47, 95%CI:0.27;0.80; p = 0.007). A significant interaction between the intervention, CRP and blood eosinophil count at hospital admission was found, with azithromycin significantly reducing hospital readmissions in patients with high CRP (> 50 mg/L, RR = 0.18, 95%CI:0.05;0.60, p = 0.005), or low blood eosinophil count (<300cells/μL, RR = 0.33, 95%CI:0.17;0.64, p = 0.001). No differences were observed in treatment response by age, FEV1, CRP or blood eosinophil count in continuous analyses. CONCLUSIONS This post-hoc analysis of the BACE trial shows that azithromycin initiated at the onset of an infectious COPD exacerbation requiring hospitalization reduces the incidence rate of TF within 3 m by preventing hospital readmissions. In patients with high CRP or low blood eosinophil count at admission this treatment effect was more pronounced, suggesting a potential role for these biomarkers in guiding azithromycin therapy. TRIAL REGISTRATION ClinicalTrials.gov number. NCT02135354 .
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Affiliation(s)
- Kristina Vermeersch
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Ann Belmans
- I-BioStat, KU Leuven, B-3000, Leuven, Belgium
- Universiteit Hasselt, B-3500, Hasselt, Belgium
| | - Kris Bogaerts
- I-BioStat, KU Leuven, B-3000, Leuven, Belgium
- Universiteit Hasselt, B-3500, Hasselt, Belgium
| | - Iwein Gyselinck
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
| | - Nina Cardinaels
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
| | - Maria Gabrovska
- Department of Pneumology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, B-1000, Brussels, Belgium
| | - Joseph Aumann
- Department of Pneumology, Jessa Ziekenhuis, B-3500, Hasselt, Belgium
| | - Ingel K Demedts
- Department of Respiratory Medicine, AZ Delta Roeselare-Menen, B-8800, Roeselare, Belgium
| | - Jean-Louis Corhay
- Department of Pneumology, Centre Hospitalier Universitaire, site Sart-Tilman, B-4000, Liège, Belgium
| | - Eric Marchand
- Department of Pneumology, CHU-UCL-Namur, site Mont-Godinne, B-5530, Yvoir, Belgium
- Faculty of Medicine, NARILIS, Laboratory of Respiratory Physiology, University of Namur, B-5000, Namur, Belgium
| | - Hans Slabbynck
- Department of Respiratory Medicine, ZNA Middelheim, B-2020, Antwerpen, Belgium
| | | | - Stefanie Vermeersch
- Department of Respiratory Medicine, Ghent University Hospital, B-9000, Ghent, Belgium
| | - Geert M Verleden
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Thierry Troosters
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Vincent Ninane
- Department of Pneumology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, B-1000, Brussels, Belgium
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, B-9000, Ghent, Belgium
| | - Wim Janssens
- Laboratory of Respiratory Diseases, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Herestraat 49, O&NI, box 706, B-3000, Leuven, Belgium.
- Department of Respiratory Diseases, University Hospitals Leuven, B-3000, Leuven, Belgium.
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