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-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
- 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.
- Files in This Item
- There are no files associated with this item.
- Appears in
Collections - 2. Clinical Science > Department of Pulmonary, Allergy, and Critical Care Medicine > 1. Journal Articles
Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.