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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
World Allergy Organization
2022
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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 |
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author | 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 |
author_facet | 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 |
author_sort | Shim, Ji-Su |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9679363 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | World Allergy Organization |
record_format | MEDLINE/PubMed |
spelling | pubmed-96793632022-11-25 Clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: From multicenter real-world cohort data in Korea 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 World Allergy Organ J Full-Length Article 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. World Allergy Organization 2022-11-20 /pmc/articles/PMC9679363/ /pubmed/36438190 http://dx.doi.org/10.1016/j.waojou.2022.100720 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Full-Length Article 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 Clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: From multicenter real-world cohort data in Korea |
title | Clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: From multicenter real-world cohort data in Korea |
title_full | Clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: From multicenter real-world cohort data in Korea |
title_fullStr | Clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: From multicenter real-world cohort data in Korea |
title_full_unstemmed | Clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: From multicenter real-world cohort data in Korea |
title_short | Clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: From multicenter real-world cohort data in Korea |
title_sort | clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: from multicenter real-world cohort data in korea |
topic | Full-Length Article |
url | 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 |
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