azithromycin + inhaled corticosteroids

The COPERNICOS trial (NCT04481555) evaluates a personalized treatment strategy for patients with severe or very severe chronic obstructive pulmonary disease (COPD) who are currently receiving triple therapy (LABA/LAMA/ICS). The intervention involves a four-arm factorial design testing two primary components: an eosinophil-guided reduction of inhaled corticosteroids (ICS) and prophylactic azithromycin. In the ICS-sparing arm, ICS treatment is paused if blood eosinophil counts are below 0.3 × 10⁹ cells/L and resumed if they rise above this threshold. This is combined with or compared against low-dose azithromycin (250 mg three times weekly). The study is led by the Chronic Obstructive Pulmonary Disease Trial Network in Denmark and aims to determine if this personalized approach can reduce ICS overtreatment and associated adverse effects while maintaining clinical efficacy and reducing hospitalizations.

Other names

COPERNICOS trial interventionEosinophil-guided ICS reduction and azithromycinEosinophil-guided Reduction of Inhaled Corticosteroids