David M Mannino1, Ruth Tal-Singer2, David A Lomas3, Jorgen Vestbo4, R Graham Barr5, Kay Tetzlaff6, Michael Lowings7, Stephen I Rennard8, Jeffrey Snyder9, Mitchell Goldman10, Ubaldo J Martin10, Deborah Merrill11, Amber L Martin12, Jason C Simeone12, Kyle Fahrbach12, Brian Murphy12, Nancy Leidy12, Bruce Miller2. 1. Department of Preventive Medicine and Environmental Health, University of Kentucky, College of Public Health, Lexington. 2. Respiratory Therapy Area Unit, GlaxoSmithKline, Philadelphia, Pennsylvania. 3. Wolfson Institute for Biomedical Research, University College London, United Kingdom. 4. Department of Respiratory Medicine, Odense University Hospital & University of Southern Denmark, Odense, Denmark, and Manchester Academic Health Science Centre, University of Manchester, United Kingdom. 5. Department of Medicine, Department of Epidemiology, Columbia University Medical Center, New York, New York. 6. Therapeutic Area Respiratory Diseases, Boehringer Ingelheim Pharma GmbH Co KG, Ingelheim, Germany, and Department of Sports Medicine, Medical Clinic V, University of Tuebingen, Germany. 7. Global Regulatory Affairs, GlaxoSmithKline Research and Development, Middlesex, United Kingdom. 8. Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Omaha. 9. Regulatory Affairs, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut. 10. Global Medicine Development, AstraZeneca LP, Wilmington, Delaware. 11. COPD Foundation, Washington, D.C. 12. Health Economics and Epidemiology, Evidera, Lexington, Massachusetts.
Abstract
BACKGROUND: In 2010 the COPD Foundation established the COPD Biomarkers Qualification Consortium (CBQC) as a partnership between the Foundation, the Food and Drug Administration (FDA), and the pharmaceutical industry to pool publicly-funded and industry data to develop innovative tools to facilitate the development and approval of new therapies for COPD. We present data from the initial project seeking regulatory qualification of fibrinogen as a biomarker for the stratification of COPD patients into clinical trials. METHODS: This analysis pooled data from 4 publicly-funded studies and 1 industry study into a common database resulting in 6376 individuals with spirometric evidence of COPD. We used a threshold of 350 mg/dL to determine high vs. low fibrinogen, and determined the subsequent risk of hospitalizations from exacerbations and death using Cox proportional hazards models. RESULTS: High fibrinogen levels at baseline were present in 2853 (44.7%) of individuals with COPD. High fibrinogen was associated with an increased risk of hospitalized COPD exacerbations within 12 months (hazard ratio [HR]: 1.64; 95% confidence interval [CI]: 1.39-1.93) among participants in the Atherosclerosis Risk in Communities Study (ARIC), the Cardiovascular Health Study (CHS), and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. High fibrinogen was associated with an increased risk of death within 36 months (HR: 1.94; 95% CI: 1.62-2.31) among all participants. CONCLUSIONS: Fibrinogen levels ≥ 350 mg/dL identify COPD individuals at an increased risk of exacerbations and death and could be a useful biomarker for enriching clinical trials in the COPD population.
BACKGROUND: In 2010 the COPD Foundation established the COPD Biomarkers Qualification Consortium (CBQC) as a partnership between the Foundation, the Food and Drug Administration (FDA), and the pharmaceutical industry to pool publicly-funded and industry data to develop innovative tools to facilitate the development and approval of new therapies for COPD. We present data from the initial project seeking regulatory qualification of fibrinogen as a biomarker for the stratification of COPDpatients into clinical trials. METHODS: This analysis pooled data from 4 publicly-funded studies and 1 industry study into a common database resulting in 6376 individuals with spirometric evidence of COPD. We used a threshold of 350 mg/dL to determine high vs. low fibrinogen, and determined the subsequent risk of hospitalizations from exacerbations and death using Cox proportional hazards models. RESULTS: High fibrinogen levels at baseline were present in 2853 (44.7%) of individuals with COPD. High fibrinogen was associated with an increased risk of hospitalized COPD exacerbations within 12 months (hazard ratio [HR]: 1.64; 95% confidence interval [CI]: 1.39-1.93) among participants in the Atherosclerosis Risk in Communities Study (ARIC), the Cardiovascular Health Study (CHS), and the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. High fibrinogen was associated with an increased risk of death within 36 months (HR: 1.94; 95% CI: 1.62-2.31) among all participants. CONCLUSIONS:Fibrinogen levels ≥ 350 mg/dL identify COPD individuals at an increased risk of exacerbations and death and could be a useful biomarker for enriching clinical trials in the COPD population.
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