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Clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: From multicenter real-world cohort data in Korea

BACKGROUND: Tiotropium, a long-acting muscarinic antagonist, is recommended for add-on therapy to inhaled corticosteroids (ICS)-long-acting beta 2 agonists (LABA) for severe asthma. However, real-world studies on the predictors of response to tiotropium are limited. We investigated the real-world us...

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Detalles Bibliográficos
Autores principales: Shim, Ji-Su, Jin, Juhae, Kim, Sae-Hoon, Lee, Taehoon, Jang, An-Soo, Park, Chan Sun, Jung, Jae-Woo, Kwon, Jae-Woo, Moon, Ji-Yong, Yang, Min-Suk, Lee, Jaechun, Choi, Jeong-Hee, Shin, Yoo Seob, Kim, Hee-Kyoo, Kim, Sujeong, Kim, Joo-Hee, Cho, Sang-Heon, Nam, Young-Hee, Kim, Sang-Hoon, Park, So Young, Hur, Gyu Young, Kim, Sang-Ha, Park, Hye-Kyung, Jin, Hyun Jung, Lee, Jae-Hyun, Park, Jung-Won, Yoon, Ho Joo, Choi, Byoung Whui, Cho, Young-Joo, Kim, Min-Hye, Kim, Tae-Bum
Formato: Online Artículo Texto
Lenguaje:English
Publicado: World Allergy Organization 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9679363/
https://www.ncbi.nlm.nih.gov/pubmed/36438190
http://dx.doi.org/10.1016/j.waojou.2022.100720
Descripción
Sumario:BACKGROUND: Tiotropium, a long-acting muscarinic antagonist, is recommended for add-on therapy to inhaled corticosteroids (ICS)-long-acting beta 2 agonists (LABA) for severe asthma. However, real-world studies on the predictors of response to tiotropium are limited. We investigated the real-world use of tiotropium in asthmatic adult patients in Korea and we identified predictors of positive response to tiotropium add-on. METHODS: We performed a multicenter, retrospective, cohort study using data from the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA). We enrolled asthmatic participants who took ICS-LABA with at least 2 consecutive lung function tests at 3-month intervals. We compared tiotropium users and non-users, as well as tiotropium responders and non-responders to predict positive responses to tiotropium, defined as 1) increase in forced expiratory volume in 1 s (FEV1) ≥ 10% or 100 mL; and 2) increase in asthma control test (ACT) score ≥3 after 3 months of treatment. RESULTS: The study included 413 tiotropium users and 1756 tiotropium non-users. Tiotropium users had low baseline lung function and high exacerbation rate, suggesting more severe asthma. Clinical predictors for positive response to tiotropium add-on were 1) positive bronchodilator response (BDR) [odds ratio (OR) = 6.8, 95% confidence interval (CI): 1.6–47.4, P = 0.021] for FEV1 responders; 2) doctor-diagnosed asthma-chronic obstructive pulmonary disease overlap (ACO) [OR = 12.6, 95% CI: 1.8–161.5, P = 0.024], and 3) initial ACT score <20 [OR = 24.1, 95% CI: 5.45–158.8, P < 0.001] for ACT responders. FEV1 responders also showed a longer exacerbation-free period than those with no FEV1 increase (P = 0.014), yielding a hazard ratio for the first asthma exacerbation of 0.5 (95% CI: 0.3–0.9, P = 0.016). CONCLUSIONS: The results of this study suggest that tiotropium add-on for uncontrolled asthma with ICS-LABA would be more effective in patients with positive BDR or ACO. Additionally, an increase in FEV1 following tiotropium may predict a lower risk of asthma exacerbation.