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 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.本研究旨在探讨血清总免疫球蛋白E（total serum IgE, T-IgE）能否作为生物标志物，指导稳定期慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）患者的个体化吸入性糖皮质激素（inhaled corticosteroid, ICS）治疗。本研究针对稳定期COPD患者开展了回顾性队列（n=1236）与前瞻性队列（n=540）研究。研究对象按基线T-IgE水平进行分层，截断值设定为100 IU/mL与76 IU/mL。采用倾向得分匹配（propensity-score matching, PSM）平衡混杂因素，并构建多变量负二项回归模型，以评估ICS对急性加重风险的影响。此外，本研究还分析了血清总IgE的稳定性及其与肺功能的相关性。在T-IgE≥100 IU/mL的亚组中，COPD患者的急性加重风险显著升高：中度急性加重的发病率比（incidence rate ratios, IRRs）为1.60（95%置信区间1.11~2.29），中度或重度急性加重的IRRs为1.37（1.03~1.82），所有类型急性加重的IRRs为1.15（1.00~1.31）。该亚组中，ICS治疗可显著降低上述急性加重风险，对应的IRRs分别为0.62（0.42~0.91）、0.73（0.53~1.00）与0.84（0.72~0.99）。与之相比，在T-IgE相关亚组中，血清总IgE水平与COPD急性加重密切相关。IgE水平升高的患者接受ICS治疗后，急性加重率可有所降低。