Lung Function in Asthma Improves With Add-On Tiotropium

Regardless of immunoglobulin E levels and blood eosinophil counts, add-on tiotropium improved lung function.
Regardless of immunoglobulin E levels and blood eosinophil counts, add-on tiotropium improved lung function.

This article is part of MPR's coverage of the ACAAI 2018 meeting, taking place in Seattle, Washington. Our staff will report on medical research related to allergy, asthma, and more conducted by experts in the field. Check back regularly for more news from ACCAI 2018.


SEATTLE — Once daily add-on tiotropium improved lung function compared with placebo in both adult and pediatric patients with moderate asthma, according to study results presented at the 2018 Annual Meeting of the American College of Asthma, Allergy, and Immunology, held November 15 to 19 in Seattle.

Researchers analyzed the effect of biomarker status on the efficacy of add-on tiotropium in both children and adults using data from four Phase 3 clinical trials (MezzoTinA-asthma, ClinicalTrials.gov Identifier: NCT01172808/NCT01172821; RubaTinA-asthma, ClinicalTrials.gov Identifier: NCT01257230; and CanoTinA-asthma, ClinicalTrials.gov Identifier: NCT01634139). Once-daily tiotropium at doses of either 2.5 or 5.0µg via soft-mist inhaler was added to inhaled corticosteroids with and without controllers. Only the results from the 2.5µg dose, which is approved in the United States, were reported here.

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A total of 779 patients received tiotropium and 792 received placebo. Statistically significant peak forced expiratory volume in 1 second (FEV1 ) values (0-3 h; pooled MezzoTinA-asthma: 223 [185-262] mL; pooled RubaTinA-asthma plus CanoTinA-asthma: 159 [98-219] mL) and trough FEV1 values (pooled MezzoTinA-asthma: 180 [138-221] mL; pooled RubaTinA-asthma plus CanoTinA-asthma: 105 [39-170] mL) were seen at week 24. Similar differences were seen with modeling of mean treatment differences between tiotropium and placebo for peak and trough FEV1 via baseline immunoglobulin E levels and blood eosinophil counts.

Add-on tiotropium improved lung function compared with placebo regardless of immunoglobulin E levels and blood eosinophil counts.

"These findings support addition of tiotropium to [inhaled corticosteroids]/[long-acting beta-agonist] at [Global Initiative for Asthma] step 4 and 5 before considering biologics in these variably phenotypic patients," the researchers concluded.

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Reference

Meltzer E, Casale T, Shaikh A, Zaremba-Pechmann L. Add-on tiotropium: clinical improvement of moderate asthma regardless of baseline IGE/eosinophil status across age groups. Presented at: the Annual Scientific Meeting of the American College of Asthma, Allergy, and Immunology, November 15-19, 2018; Seattle, WA. Poster  P213.