PERCEPTION ON EOSINOPHIL USE IN ICS INITIATION AND WITHDRAWAL IN COPD AMONG PRIMARY CARE PHYSICIANS AND PULMONOLOGISTS IN 6 EUROPEAN COUNTRIES: RESULTS OF THE DEMETER STUDY

Aim: Blood eosinophil count is associated with clinical response to inhaled corticosteroids (ICS), particularly, for exacerbation prevention. IPCRG guidance indicates that ICS can be withdrawn in COPD patients without history of asthma, with no history of exacerbation in the previous year, and with blood eosinophils below 300µL-1, gradually when 100-300 µL-1, and abruptly when <100 µL-1. This study aims to investigate perceptions from general practitioners (GPs) and pulmonologists on the use of eosinophils and ICS withdrawal.Methods: We used the DELPHI methodology to assess the perception on COPD management and drivers for treatment decisions in Belgium, Finland, Greece, Netherlands, Norway and Portugal. An online questionnaire was sent in two waves to pulmonologists and GPs in 2020. Results: 45 GPs and 82 pulmonologists participated in both waves. 65% of the panellists found eosinophil counts very important for initial treatment selection, while 6% never measure it. The presence of ≥300 eosinophils µL-1 was associated with LABA/ICS and LAMA/LABA/ICS initiation. When starting ICS, 53% reported to always rely on both the frequency of exacerbations and eosinophil count; 49% rely on both for withdrawal. Panellists agreed that ICS-treated patients are eligible for ICS withdrawal in case of lack of response to ICS (88%), if ICS are no longer indicated (87%), in case of ICS-related side effects (81%), but not in patients with pneumonia (agreement only for pulmonologists), diabetes or cardiovascular disease. While most GPs prefer to withdraw ICS from LABA-ICS and LAMA-LABA-ICS gradually (69% and 56% respectively), pulmonologists do so abruptly (71%, 89%). 94% of panellists had experience in ICS withdrawal. Participants’ perception was that 75% of COPD patients remained exacerbation free within 6 months after ICS stop.Conclusions: In our survey, blood eosinophils are broadly used to guide treatment initiation or ICS withdrawal. GPs prefer a gradual, pulmonologists an abrupt ICD withdrawal. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest The authors received no direct compensation related to the development of the poster. This study was supported by Boehringer Ingelheim. Dr. Kocks reports grants, personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, Chiesi Pharmaceuticals, GSK, Novartis, MundiPharma and TEVA. Dr. Bakke reports lecture fees from Astra-Zeneca, Boehringer- Ingelheim, Chiesi, GSK and Novartis.Dr. van Schayck reports grants and fees from Boehringer Ingelheim, Pfizer and Chiesi. Dr. Cataldo, founder of Aquilon Pharmaceuticals, received fees from AstraZeneca, Boehringer-Ingelheim, Chiesi and GSK.Dr. Ekroos receives fees from Astra-Zeneca, Boehringer-Ingelheim and GSK. Dr. Ferreira has received speaker fees from Bial, GSK, Teva, Mylan, Menarini. References and Clinical Trial Registry Information