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Allergy and Airway |

Once-Daily Tiotropium Reduces Risk of Exacerbations and Asthma Worsening in Patients With Symptomatic Asthma Despite Treatment With Inhaled Corticosteroids and Long-Acting β2-Agonists

Donald P Tashkin, MD; Petra Moroni-Zentgraf, MD; Michael Engel, MD; Hendrik Schmidt, PhD; Huib AM Kerstjens, MD
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David Geffen School of Medicine at UCLA, Los Angeles, CA


Chest. 2013;144(4_MeetingAbstracts):90A. doi:10.1378/chest.1701739
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Abstract

SESSION TITLE: Tiotropium and Asthma

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 28, 2013 at 01:45 PM - 03:15 PM

PURPOSE: To evaluate the effect of once-daily tiotropium (5 µg [morning] via Respimat® Soft Mist™ Inhaler) on asthma exacerbations in patients with symptomatic asthma despite receiving ICS+LABA.

METHODS: Two replicate, double-blind, placebo-controlled studies (NCT00772538; NCT00776984). Eligible patients had: ≥5-year history of asthma diagnosed before aged 40 years; Asthma Control Questionnaire 7 score ≥1.5; experienced ≥1 exacerbation during previous year. Patients were either life-long non-smokers or ex-smokers (<10 pack-years) who quit smoking ≥1 year before study enrollment. Co-primary endpoint was time to first severe exacerbation from combined study data after 48 weeks (asthma deterioration necessitating initiation or doubling of systemic glucocorticosteroids for ≥3 days). Secondary endpoints included time to first episode of asthma worsening (either progressive increase in symptoms or decline of ≥30% in best morning peak expiratory flow for ≥2 consecutive days). Subgroup analysis of these endpoints was performed on a range of baseline characteristics.

RESULTS: 912 patients were randomized to receive either tiotropium (n=456) or placebo (n=456) for 48 weeks. Time to first severe exacerbation was 56 days longer with tiotropium versus placebo, corresponding to a 21% risk reduction (hazard ratio [HR] 0.79; p=0.03). A lower proportion of tiotropium patients (26.9%) experienced ≥1 severe exacerbation versus placebo (32.8%). From post hoc calculation, 15 patients were needed to treat to prevent one severe exacerbation during the treatment period. Fewer tiotropium patients (3.5%) were hospitalized due to asthma versus placebo (4.4%). Tiotropium also reduced risk of first asthma worsening (31%; HR 0.69; p<0.001). Improvement in time to first severe asthma exacerbation and first asthma worsening did not differ across subgroups subdivided by hospitalizations within past year, percentage predicted FEV1, age class, sex, allergic status, or disease duration.

CONCLUSIONS: Once-daily tiotropium as add-on to ICS+LABA reduced the risk of severe asthma exacerbation and asthma worsening compared with placebo. Findings were consistent across various subgroups.

CLINICAL IMPLICATIONS: Once-daily tiotropium is effective across a broad spectrum of patients with symptomatic asthma despite receiving ICS+LABA. Funding: Boehringer Ingelheim and Pfizer. Editorial assistance: Complete HealthVizion.

DISCLOSURE: Donald P Tashkin: Consultant fee, speaker bureau, advisory committee, etc.: Speaker fee from Boehringer Ingelheim, University grant monies: Grant from Boehringer Ingelheim, Consultant fee, speaker bureau, advisory committee, etc.: Consultant fee from AstraZeneca, Novartis, Pearl, Sunovion, University grant monies: Grants from Pearl, GlaxoSmithKline and Sunovion, Consultant fee, speaker bureau, advisory committee, etc.: Speaker Bureaus, Boehringer Ingelheim, AstraZeneca, Forest, Novartis and Pfizer Petra Moroni-Zentgraf: Employee: Boehringer Ingelheim Michael Engel: Employee: Boehringer Ingelheim Hendrik Schmidt: Employee: Boehringer Ingelheim Huib AM Kerstjens: University grant monies: Board membership - Pfizer, Almirall, GlaxoSmithKline, Takeda, Novartis, Nycomed, Chiesi, Consultant fee, speaker bureau, advisory committee, etc.: Consultancy fee - Pfizer, Almirall, GlaxoSmithKline, Novartis, Nycomed, Chiesi, AstraZeneca, Protaffin, Consultant fee, speaker bureau, advisory committee, etc.: Speaker bureau - BI, Pfizer

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