COPERNICOS Trial: Eosinophil-Guided ICS Reduction Safe in COPD, Vestbo Says

Patients with chronic obstructive pulmonary disease (COPD) actively taking inhaled corticosteroids (ICS) can often face an increased risk of adverse events, and the drugs may be overutilized as an informal standard of practice.¹

A recent late-breaking abstract presented at the 2026 European Respiratory Society (ERS) Congress showed that patients with COPD who do not meet a specific eosinophil threshold can have their ICS dose reduced without a significant increase in the risk of severe exacerbation, said Jorgen Vestbo, MD, a professor of respiratory medicine and an honorary consultant at the Northwest Lung Centre, Manchester University Hospital, and trial investigator, in an interview with The American Journal of Managed Care.

"I think it used to be a drug that you would simply pick as soon as patients got sicker and not really think of what it was that made them so sick that you wanted to give them inhaled steroids,” he said.

The abstract highlights findings from the COPD-eosinophil-guided reduction of inhaled corticosteroids (COPERNICOS; NCT04481555) trial. The randomized controlled trial assessed the risk of severe exacerbations when using eosinophil-guided ICS treatment (EGT) to reduce ICS dosing. Patients receiving EGT did not experience a significant increase in the risk of severe exacerbations or all-cause mortality compared with those on continued triple therapy, although formal non-inferiority was not demonstrated.¹

The findings, Vestbo said, should also encourage a change in habit for health care professionals prescribing ICS. He noted that clinicians should make room to properly assess patients' needs and limitations to determine whether ICS is truly necessary for them.

"Clinicians need to, first of all, accept that they have to measure the biomarker over time and be more willing to spend more time with their patients discussing why they're on the drug and why they may not need to be on the drug," he said. "And then there's the challenge for the patients to actually believe it is okay for me to take fewer drugs in the future, although I am breathless every day."

References

1. Bonnesen B, Rønn C, Alispahic I, et al. Eosinophil guided therapy for severe COPD – a randomised controlled trial for inhaled corti-costeroid treatment (the COPERNICOS trial). Presented at: European Respiratory Congress 2026; September 5-9, 2026; Barcelona, Spain.