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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 Koreaopen access

Authors
Shim, Ji-SuJin, JuhaeKim, Sae-HoonLee, TaehoonJang, An-SooPark, Chan SunJung, Jae-WooKwon, Jae-WooMoon, Ji-YongYang, Min-SukLee, JaechunChoi, Jeong-HeeShin, Yoo SeobKim, Hee-KyooKim, SujeongKim, Joo-HeeCho, Sang-HeonNam, Young-HeeKim, Sang-HoonPark, So YoungHur, Gyu YoungKim, Sang-HaPark, Hye-KyungJin, Hyun JungLee, Jae-HyunPark, Jung-WonYoon, Ho JooChoi, Byoung WhuiCho, Young-JooKim, Min-HyeKim, Tae-Bum
Issue Date
Dec-2022
Publisher
Lippincott Williams & Wilkins Ltd.
Keywords
Tiotropium; Muscarinic antagonists; Asthma; Treatment response; Predictor
Citation
World Allergy Organization Journal, v.15, no.12
Indexed
SCIE
SCOPUS
Journal Title
World Allergy Organization Journal
Volume
15
Number
12
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/62351
DOI
10.1016/j.waojou.2022.100720
ISSN
1939-4551
Abstract
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.
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Guro Hospital (Department of Pulmonary, Allergy, and Critical Care Medicine, Guro Hospital)
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