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, MD, PhD; Juhae Jin, MA; Sae-Hoon Kim, MD, PhD; Taehoon Lee, MD, PhD; An-Soo Jang, MD, PhD; Chan Sun Park, MD, PhD; Jae-Woo Jung, MD, PhD; Jae-Woo Kwon, MD, PhD; Ji-Yong Moon, MD, PhD; Min-Suk Yang, MD, PhD; Jaechun Lee, MD, PhD; Jeong-Hee Choi, MD, PhD; Yoo Seob Shin, MD, PhD; Hee-Kyoo Kim, MD, PhD; Sujeong Kim, MD, PhD; Joo-Hee Kim, MD, PhD; Sang-Heon Cho, MD, PhD; Young-Hee Nam, MD, PhD; Sang-Hoon Kim, MD, PhD; So Young Park, MD, PhD; Gyu Young Hur, MD, PhD; Sang-Ha Kim, MD, PhD; Hye-Kyung Park, MD, PhD; Hyun Jung Jin, MD, PhD; Jae-Hyun Lee, MD, PhD; Jung-Won Park, MD, PhD; Ho Joo Yoon, MD, PhD; Byoung Whui Choi, MD, PhD; Young-Joo Cho, MD, PhD; Min-Hye Kim, MD, PhD; Tae-Bum Kim, MD, PhD

World Allergy Organization Journal (Dec 2022)

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, MD, PhD,
Juhae Jin, MA,
Sae-Hoon Kim, MD, PhD,
Taehoon Lee, MD, PhD,
An-Soo Jang, MD, PhD,
Chan Sun Park, MD, PhD,
Jae-Woo Jung, MD, PhD,
Jae-Woo Kwon, MD, PhD,
Ji-Yong Moon, MD, PhD,
Min-Suk Yang, MD, PhD,
Jaechun Lee, MD, PhD,
Jeong-Hee Choi, MD, PhD,
Yoo Seob Shin, MD, PhD,
Hee-Kyoo Kim, MD, PhD,
Sujeong Kim, MD, PhD,
Joo-Hee Kim, MD, PhD,
Sang-Heon Cho, MD, PhD,
Young-Hee Nam, MD, PhD,
Sang-Hoon Kim, MD, PhD,
So Young Park, MD, PhD,
Gyu Young Hur, MD, PhD,
Sang-Ha Kim, MD, PhD,
Hye-Kyung Park, MD, PhD,
Hyun Jung Jin, MD, PhD,
Jae-Hyun Lee, MD, PhD,
Jung-Won Park, MD, PhD,
Ho Joo Yoon, MD, PhD,
Byoung Whui Choi, MD, PhD,
Young-Joo Cho, MD, PhD,
Min-Hye Kim, MD, PhD,
Tae-Bum Kim, MD, PhD

Affiliations

Ji-Su Shim, MD, PhD: Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea
Juhae Jin, MA: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Sae-Hoon Kim, MD, PhD: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
Taehoon Lee, MD, PhD: Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
An-Soo Jang, MD, PhD: Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
Chan Sun Park, MD, PhD: Department of Internal Medicine, Inje University, Haeundae Paik Hospital, Busan, South Korea
Jae-Woo Jung, MD, PhD: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
Jae-Woo Kwon, MD, PhD: Department of Internal Medicine, Kangwon University School of Medicine, Chuncheon, South Korea
Ji-Yong Moon, MD, PhD: Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
Min-Suk Yang, MD, PhD: Department of Internal Medicine, SMG-SNU Borame Medical Center, Seoul, South Korea
Jaechun Lee, MD, PhD: Department of Internal Medicine, Jeju National University School of Medicine, Jeju, South Korea
Jeong-Hee Choi, MD, PhD: Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea; Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, South Korea
Yoo Seob Shin, MD, PhD: Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
Hee-Kyoo Kim, MD, PhD: Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
Sujeong Kim, MD, PhD: Department of Internal Medicine, Kyungpook National University, Daegu, South Korea
Joo-Hee Kim, MD, PhD: Department of Internal Medicine, Hallym University College of Medicine, Anyang, South Korea
Sang-Heon Cho, MD, PhD: Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Young-Hee Nam, MD, PhD: Department of Internal Medicine, Dong-A University School of Medicine, Busan, South Korea
Sang-Hoon Kim, MD, PhD: Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, South Korea
So Young Park, MD, PhD: Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
Gyu Young Hur, MD, PhD: Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
Sang-Ha Kim, MD, PhD: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
Hye-Kyung Park, MD, PhD: Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea
Hyun Jung Jin, MD, PhD: Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
Jae-Hyun Lee, MD, PhD: Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
Jung-Won Park, MD, PhD: Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
Ho Joo Yoon, MD, PhD: Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
Byoung Whui Choi, MD, PhD: Department of Internal Medicine, Chung-Ang University H.C.S. Hyundai Hospital, Gyeonggi-do, South Korea
Young-Joo Cho, MD, PhD: Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea
Min-Hye Kim, MD, PhD: Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea; Corresponding author. Department of Internal Medicine, Ewha Womans University College of Medicine, 260 Gonghang-daero, Gangseo-gu, Seoul 07804, Republic of Korea.
Tae-Bum Kim, MD, PhD: Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Corresponding author. Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.

Journal volume & issue: Vol. 15, no. 12
p. 100720

Abstract

Read online

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.

Published in World Allergy Organization Journal

ISSN: 1939-4551 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Immunologic diseases. Allergy
Website: https://www.sciencedirect.com/journal/world-allergy-organization-journal

About the journal

Abstract

Keywords