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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

 Ji-Su Shim  ;  Juhae Jin  ;  Sae-Hoon Kim  ;  Taehoon Lee  ;  An-Soo Jang  ;  Chan Sun Park  ;  Jae-Woo Jung  ;  Jae-Woo Kwon  ;  Ji-Yong Moon  ;  Min-Suk Yang  ;  Jaechun Lee  ;  Jeong-Hee Choi  ;  Yoo Seob Shin  ;  Hee-Kyoo Kim  ;  Sujeong Kim  ;  Joo-Hee Kim  ;  Sang-Heon Cho  ;  Young-Hee Nam  ;  Sang-Hoon Kim  ;  So Young Park  ;  Gyu Young Hur  ;  Sang-Ha Kim  ;  Hye-Kyung Park  ;  Hyun Jung Jin  ;  Jae-Hyun Lee  ;  Jung-Won Park  ;  Ho Joo Yoon  ;  Byoung Whui Choi  ;  Young-Joo Cho  ;  Min-Hye Kim  ;  Tae-Bum Kim 
 WORLD ALLERGY ORGANIZATION JOURNAL, Vol.15(12) : 100720, 2022-11 
Journal Title
Issue Date
Asthma ; Muscarinic antagonists ; Predictor ; Tiotropium ; Treatment response
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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jung Won(박중원) ORCID logo https://orcid.org/0000-0003-0249-8749
Lee, Jae Hyun(이재현) ORCID logo https://orcid.org/0000-0002-0760-0071
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