Predictors of response to tiotropium versus salmeterol in asthmatic adults.

Abstract

BACKGROUND:

Tiotropium has activity as an asthma controller. However, predictors of a positive response to tiotropium have not been described.

OBJECTIVE:

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.

METHODS:

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).

RESULTS:

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.

CONCLUSION:

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.

• Authors: Stephen 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, National Heart, Lung, and Blood Institute's Asthma Clinical Research Network
• Journal: The 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
• PMID: 24084072 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 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

Topics

• 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