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Jump to Key Points Eosinophil-guided therapy (EGT) significantly reduced the use of inhaled corticosteroids (ICS) in adults with severe chronic obstructive pulmonary disease (COPD) compared with continued triple therapy, according to late-breaking data presented at the European Respiratory Society (ERS) 2026 International Congress.
Adverse effects are associated with extended use of ICS, and blood eosinophil levels are known biomarkers for airway inflammation, but the potential of EGT to reduce ICS use in these patients remains unknown, said Barbara Bronnesen Bertelsen, MD, PhD, a pulmonologist at Gentofte University Hospital, Copenhagen, Denmark, and colleagues.
In the study, known as COPERNICOS, the researchers enrolled 444 adults with severe or very severe COPD, defined as GOLD E or forced expiratory volume in 1 second of less than 30% on ICS/long-acting muscarinic antagonist/long-acting beta2-agonists. The mean age of the participants was 72 years, and 51% were female. Participants were randomized to an EGT strategy of switch on/switch off of ICS, based on eosinophil levels and updated every 3 months, or continued triple therapy.
Overall, patients in the EGT group had a 28% reduction in daily budesonide equivalent ICS compared with those who continued triple therapy (502 µg vs 696 µg; P < .001). Use of systemic steroids averaged 0.51 mg in both groups (P = .50).
- EGT reduced daily budesonide-equivalent ICS dose 28% vs continued triple therapy.
- Severe COPD adults (GOLD E or FEV1 <30%) randomized; mean age 72, 51% female.
- Severe exacerbations and all-cause mortality were not significantly increased over 1 year.
- Pneumonia risk was similar despite lower ICS exposure in the EGT arm.
- Open-label design; noninferiority not formally demonstrated; longer blinded trials needed.
In addition, patients in the EGT group had no significantly increased risk of severe exacerbations or all-cause mortality over a 1-year period, with an incidence rate ratio of 1.06 (95% CI, 0.69-1.62; P = .77) and totals of 210 and 176 events, respectively. The risk of pneumonia was similar across the EGT and control groups.
More research is needed to confirm the results, and the findings were limited by the open-label design, the researchers noted. Although the study was not able to demonstrate formal noninferiority, it is the first known to show the ability of EGT to reduce cumulative ICS dose with no significant adverse effects, they said.
Patient Identification and Risk Reduction
"While inhaled corticosteroids help reduce COPD exacerbations, they carry significant risks of adverse events like pneumonia; therefore, it is important to determine when and for whom this could be discontinued or reduced to minimize adverse events," said Arianne K. Baldomero, MD, MS, associate professor of medicine at the University of Minnesota, Minneapolis.
"The most surprising finding was that pneumonia risk remained similar between both groups despite a 28% reduction in daily ICS dose in the EGT arm," said Baldomero, who was not involved in the study.
The researchers did not explain the specific methodology for discontinuing ICS in the current study, said Baldomero. However, the results suggest the possibility of decreasing ICS dose without increasing the risk for severe exacerbations or all-cause mortality using EGT, even among patients with severe COPD, she said.
More research is needed in the form of larger, double-blinded trials to establish noninferiority and longer follow-up periods to evaluate long-term safety and potential pneumonia reduction, Baldomero added.
The study was supported in part by Copenhagen University and the Novo Nordisk Foundation. Full disclosure information for authors is available with the original study protocol. Baldomero reported no relevant financial relationships.
