Predictors of response to tiotropium versus salmeterol in asthmatic adults.

Tiotropium has activity as an asthma controller. However, predictors of a positive response to tiotropium have not been described.
We sought to describe individual and differential responses of asthmatic patients to salmeterol and tiotropium when added to an inhaled corticosteroid, as well as predictors of a positive clinical response.
Data from the double-blind, 3-way, crossover National Heart, Lung, and Blood Institute's Asthma Clinical Research Network's Tiotropium Bromide as an Alternative to Increased Inhaled Glucocorticoid in Patients Inadequately Controlled on a Lower Dose of Inhaled Corticosteroid (ClinicalTrials.gov number, NCT00565266) trial were analyzed for individual and differential treatment responses to salmeterol and tiotropium and predictors of a positive response to the end points FEV1, morning peak expiratory flow (PEF), and asthma control days (ACDs).
Although approximately equal numbers of patients showed a differential response to salmeterol and tiotropium in terms of morning PEF (n = 90 and 78, respectively) and ACDs (n = 49 and 53, respectively), more showed a differential response to tiotropium for FEV1 (n = 104) than salmeterol (n = 62). An acute response to a short-acting bronchodilator, especially albuterol, predicted a positive clinical response to tiotropium for FEV1 (odds ratio, 4.08; 95% CI, 2.00-8.31; P < .001) and morning PEF (odds ratio, 2.12; 95% CI, 1.12-4.01; P = 0.021), as did a decreased FEV1/forced vital capacity ratio (FEV1 response increased 0.39% of baseline for every 1% decrease in FEV1/forced vital capacity ratio). Higher cholinergic tone was also a predictor, whereas ethnicity, sex, atopy, IgE level, sputum eosinophil count, fraction of exhaled nitric oxide, asthma duration, and body mass index were not.
Although these results require confirmation, predictors of a positive clinical response to tiotropium include a positive response to albuterol and airway obstruction, factors that could help identify appropriate patients for this therapy.
AuthorsStephen P Peters, Eugene R Bleecker, Susan J Kunselman, Nikolina Icitovic, Wendy C Moore, Rodolfo Pascual, Bill T Ameredes, Homer A Boushey, William J Calhoun, Mario Castro, Reuben M Cherniack, Timothy Craig, Loren C Denlinger, Linda L Engle, Emily A Dimango, Elliot Israel, Monica Kraft, Stephen C Lazarus, Robert F Lemanske Jr, Njira Lugogo, Richard J Martin, Deborah A Meyers, Joe Ramsdell, Christine A Sorkness, E Rand Sutherland, Stephen I Wasserman, Michael J Walter, Michael E Wechsler, Vernon M Chinchilli, Stanley J Szefler,
JournalThe Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 132 Issue 5 Pg. 1068-1074.e1 (Nov 2013) ISSN: 1097-6825 [Electronic] United States
PMID24084072 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
Chemical References
  • Adrenergic beta-2 Receptor Agonists
  • Anti-Asthmatic Agents
  • Bronchodilator Agents
  • Scopolamine Derivatives
  • Salmeterol Xinafoate
  • Albuterol
  • Tiotropium Bromide
  • Adrenergic beta-2 Receptor Agonists (therapeutic use)
  • Adult
  • Albuterol (analogs & derivatives, therapeutic use)
  • Anti-Asthmatic Agents (therapeutic use)
  • Asthma (diagnosis, drug therapy)
  • Bronchodilator Agents (therapeutic use)
  • Cross-Over Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Salmeterol Xinafoate
  • Scopolamine Derivatives (therapeutic use)
  • Tiotropium Bromide
  • Treatment Outcome

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research network!

Choose Username:
Verify Password: