IgE Guided Use of ICS in Patients with Stable COPD: A Real-World Observational Study

This study investigated whether total serum IgE (T-IgE) can serve as a biomarker to guide personalized inhaled corticosteroid (ICS) therapy in patients with stable chronic obstructive pulmonary disease (COPD).
We conducted retrospective (n = 1236) and prospective (n = 540) cohort studies of stable COPD patients. Participants were stratified by baseline T-IgE levels (cutoffs: 100 and 76 IU/mL). Propensity-score matching (PSM) was used to balance confounding factors, and a multivariate negative binomial regression model was constructed to evaluate the effects of ICS on the risks of exacerbations. Additionally, the stability of total serum IgE and its correlation with pulmonary function were analyzed.
In the subgroup with T-IgE ≥ 100 IU/mL, COPD patients had a significantly increased risk of exacerbations, with incidence rate ratios (IRRs) of 1.60 (95% CI 1.11–2.29) for moderate exacerbations, 1.37 (1.03–1.82) for moderate or severe exacerbations, and 1.15 (1.00–1.31) for all exacerbations. In this subgroup, ICS treatment significantly reduced the risk of the aforementioned exacerbations, with corresponding IRRs of 0.62 (0.42–0.91), 0.73 (0.53–1.00), and 0.84 (0.72–0.99). In contrast, in the T-IgE < 100 IU/mL subgroup, the benefits of ICS treatment were not statistically significant. Furthermore, total serum IgE demonstrated better stability than blood eosinophil counts and was negatively correlated with pulmonary function indices. Consistent results were obtained using a cutoff value of 76 IU/mL.
The total serum IgE level is closely related to exacerbations of COPD. Patients with high IgE levels can experience a reduced exacerbation rate when treated with ICS.