Variability of blood eosinophil count as an asthma biomarker

Mathur, Sameer K.; Fichtinger, Paul S.; Evans, Michael D.; Schwantes, Elizabeth A.; Jarjour, Nizar N.

doi:10.1016/j.anai.2016.08.010

Cited by 35 publications

(34 citation statements)

References 7 publications

(7 reference statements)

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“…Measures of blood eosinophil count tend to have a great deal of variability [41–43]. Mathur and colleagues [42] found that a typical eosinophil count in any given individual was approximately 40% greater or lesser than that individual’s mean. They also found that only 2% of the within-patient variability in eosinophil counts could be attributed to the month of collection (seasonal allergies), and less than 1% could be attributed to inhaled corticosteroid use.…”

Section: Discussionmentioning

confidence: 99%

Health care resource utilization and characteristics of patients with eosinophilic asthma in secondary health care in Finland

Mäkelä

Christensen

Karlsson

et al. 2018

European Clinical Respiratory Journal

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Background: Eosinophilic airway inflammation is common in asthma patients and appears to be associated with severe exacerbations and loss of asthma control. Objective: To describe the resource utilization and clinical characteristics of patients with eosinophilic asthma. Design: Asthma patients ≥18 years with ≥1 blood eosinophil count in secondary care (South West Finland) during 2003‒2013 were included. Clinical characteristics (age, lung function, body mass index, and comorbidities) and asthma-related resource utilization (hospital admissions, outpatient visits, and emergency room [ER] visits) were retrieved. Resource utilization rates were compared for patients with blood eosinophil ≤ or >300 cells/μL, using adjusted negative binomial regression models. Results: Overall, 4,357 eligible patients were identified (mean age 60 years, females 68%), of which 1,927 (44%) had >300 eosinophil cells/μL blood. Patients with ≤300 and >300 eosinophil counts, exhibited similar clinical characteristics, including advanced age, poor lung function, and overweight. Comorbidities such as pneumonia, sinusitis, and nasal polyps, were more frequent among those with >300 eosinophil cells/μL blood compared with patients with lower counts. Eosinophil counts >300 cells/μL were associated with greater hospital admissions (rate ratio [RR] [95% confidence interval CI]: 1.13 [1.02;1.24]) and outpatient visits (RR [95% CI]: 1.11 [1.03;1.20]) compared with patients with lower eosinophil counts. Rates of ER visits were similar between the patient groups (RR [95% CI]: 0.99 [0.87;1.12]). Conclusions: Hospital admissions and outpatient visits occurred more often for patients with eosinophil counts >300 cells/µL, than for patients with lower eosinophil counts. Routine blood eosinophil screening might be useful to identify patients with an eosinophilic phenotype eligible for more targeted treatments.

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Section: Discussionmentioning

confidence: 99%

Health care resource utilization and characteristics of patients with eosinophilic asthma in secondary health care in Finland

Mäkelä

Christensen

Karlsson

et al. 2018

European Clinical Respiratory Journal

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“…More detailed characterization of the eosinophilic phenotype beyond blood eosinophil counts is needed that uses a combination of clinical characteristics (e.g., nasal polyposis), along with blood eosinophil counts 27 . Blood eosinophil counts should be measured at several time points to address variability issues that could cause missed diagnoses for patients with eosinophilic inflammation 32 . The data from our current analysis demonstrate that benralizumab has clinical efficacy at blood eosinophil counts !150 cells/lL for patients with severe uncontrolled asthma, although greater eosinophil counts were predictive of a greater magnitude of response across asthma outcomes, including exacerbations, lung function, and symptomatology.…”

Section: Discussionmentioning

confidence: 99%

The association between blood eosinophil count and benralizumab efficacy for patients with severe, uncontrolled asthma: subanalyses of the Phase III SIROCCO and CALIMA studies

Goldman

Hirsch

Zangrilli

et al. 2017

Current Medical Research and Opinion

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“…22 Blood levels were used for the first large-scale study demonstrating efficacy of anti-IL-5 treatment 18 and have been used for subsequent studies. 32 Post hoc analysis of clinical trials for mepolizumab suggests stability of blood eosinophil counts in patients enrolled based on their elevated baseline eosinophil count. Blood eosinophils do not consistently reflect airway eosinophil levels.…”

mentioning

confidence: 99%

“…30,31 A study of 82 individuals with and without mild asthma suggested a within-subject geometric coefficient of variation of 39.7%. 32 Post hoc analysis of clinical trials for mepolizumab suggests stability of blood eosinophil counts in patients enrolled based on their elevated baseline eosinophil count. 22,33 The stability of blood eosinophil levels on repeated measurements in real-world populations remains poorly described.…”

mentioning

confidence: 99%

Variability of blood eosinophils in patients in a clinic for severe asthma

Rakowski

Zhao

Liu

et al. 2019

Clin Experimental Allergy

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Background: Blood eosinophils are used to determine eligibility for agents targeting IL-5 in patients with uncontrolled asthma. However, little is known about the variability of blood eosinophil measures in these patients before treatment initiation.Objective: To characterize variability and patterns of variability of blood eosinophil levels in a real-world clinic for severe asthmatics.Methods: Retrospective review of blood eosinophils measured over a 5-year period in patients enrolled in an urban clinic. Repeated measures of blood eosinophil levels in individuals were evaluated, and cluster analysis was performed to characterize patients by eosinophil patterns. Clinical characteristics associated with eosinophil levels and patterns of variability were analysed. Results:Patients treated in the Bellevue Hospital Asthma Clinic within a 3-month period were identified (n = 219). Blood eosinophil measures were obtained over the previous 5 years. Only 6% (n = 13) of patients had levels that were consistently above 300 cells/μL. Nearly 50% (n = 104) had eosinophil levels that traversed the threshold of 300 cells/μL. In contrast, 102 (46%) had levels that never reached the threshold of 300 cells/μL. Cluster analyses revealed three clusters with differing patterns of levels and variability. There was a suggestion of decreased clinical control and increased atopy in the cluster with the greatest variability in blood eosinophil measures. Conclusion:In an urban clinic for patients referred for uncontrolled asthma, blood measures of eosinophils were variable and showed differing patterns of variability.These data reinforce the need to perform repeated eosinophil blood measures for appropriate designation for therapeutic intervention.

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Variability of blood eosinophil count as an asthma biomarker

Cited by 35 publications

References 7 publications

Health care resource utilization and characteristics of patients with eosinophilic asthma in secondary health care in Finland

Health care resource utilization and characteristics of patients with eosinophilic asthma in secondary health care in Finland

The association between blood eosinophil count and benralizumab efficacy for patients with severe, uncontrolled asthma: subanalyses of the Phase III SIROCCO and CALIMA studies

Variability of blood eosinophils in patients in a clinic for severe asthma

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