Tiotropium added to low- to medium-dose inhaled corticosteroids (ICS) versus low- to medium-dose ICS alone for adults with mild to moderate uncontrolled persistent asthma: A systematic review and meta-analysis

Wang, Liqun; Zhou, Rui; Xie, Xiaohui

doi:10.1080/02770903.2018.1424192

Cited by 9 publications

(8 citation statements)

References 14 publications

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“…46 Furthermore, in another systematic review of 3 RCTs of approximately 900 school-age children, tiotropium significantly improved lung function and decreased the number of patients with at least 1 exacerbation compared with placebo. 45 Finally, consistent with our findings, a pooled analysis of safety data from trials in adolescents and children with symptomatic moderate asthma found that the most commonly reported AEs with tiotropium treatment included asthma worsening, exacerbations, decreased PEF, nasopharyngitis, viral respiratory tract infection, and respiratory tract infection. 48,49 Limitations of our findings include inadequate data regarding the efficacy and safety of tiotropium in preschool children.…”

Section: Discussionsupporting

confidence: 89%

“…24 Findings from the present systematic review, like those from systematic reviews of the adult tiotropium trials, reinforce the efficacy and safety of tiotropium in adolescents and children (Supplementary Video 1). 33,44,45 Furthermore, by being able to evaluate all 7 phase 2/3 RCTs of tiotropium as add-on LAMA therapy conducted in children and adolescents with asthma that is uncontrolled despite ICS use, our findings confirm and expand on previously published systematic reviews. 46,47 In a systematic review and meta-analysis of the 3 RCTs of approximately 1000 adolescents (mean age, 14 years) with moderate to severe asthma, tiotropium was deemed well tolerated and efficacious as add-on therapy to maintenance ICS treatment or an ICS plus a LABA.…”

Section: Discussionsupporting

confidence: 78%

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Tiotropium in children and adolescents with asthma

Murphy

Chipps

2020

Annals of Allergy, Asthma & Immunology

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Background: Asthma is a major cause of morbidity in children, despite the availability of various treatments. In adults, tiotropiumda long-acting muscarinic antagonistdas add-on therapy to an inhaled corticosteroid with or without a long-acting b 2 -agonist provides clinical benefit with a safety profile similar to placebo.Objective: To review published evidence on the efficacy and safety of tiotropium as add-on a long-acting muscarinic antagonist therapy in children and adolescents with asthma that is uncontrolled despite use of an inhaled corticosteroid with or without additional controller medication(s). Methods: We searched PubMed from inception until June 12, 2018, for randomized controlled trials of children and adolescents aged 1 to 17 years treated with tiotropium and reporting a primary outcome of any pulmonary function test and a secondary outcome of adverse events. Results: Overall, 7 randomized controlled trials of 1902 preschool children (aged 1-5 years; n ¼ 102), schoolage children (aged 6-11 years; n ¼ 905), and adolescents (aged 12-17 years; n ¼ 895) with moderate to severe asthma were included in the analysis. Once-daily tiotropium (5, 2.5, or 1.25 mg) improved lung function parameters, including peak and trough forced expiratory volume in 1 second, vs placebo. Commonly reported adverse events across treatment groups included asthma worsening or exacerbations, decreased peak expiratory flow rate, nasopharyngitis, viral respiratory tract infection, and respiratory tract infection. Conclusion: Once-daily tiotropium as add-on therapy is efficacious and safe in adolescents and children with moderate to severe asthma. These results support the expanded indication by regulatory authorities for add-on tiotropium in patients 6 years or older.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 78%

Tiotropium in children and adolescents with asthma

Murphy

Chipps

2020

Annals of Allergy, Asthma & Immunology

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“…A recent systematic review and meta-analysis reported that tiotropium, an anticholinergic, with low-to medium-dose ICS once daily could be an acceptable option in the treatment of adults with moderate uncontrolled asthma, with improvements in lung function noted. However, it is important to note that no statistically significant differences were found in the two studies analyzed that used the Asthma Control Questionnaire, with relevant heterogeneity detected [39]. Our study also considered long-acting muscarinic antagonists (LAMA) and SAMA in the anticholinergic drug class, while the systematic review considered tiotropium only.…”

Section: Discussionmentioning

confidence: 86%

Key factors associated with uncontrolled asthma – the Asthma Control in Latin America Study

et al. 2019

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Objective: This study aimed to estimate asthma control at specialist treatment centers in four Latin American countries and assess factors influencing poor asthma control. Methods: Patients aged !12 years with an asthma diagnosis and asthma medication prescription, followed at outpatient specialist centers in Argentina, Chile, Colombia, and Mexico, were included. The study received all applicable ethical approvals. The Asthma Control Test (ACT) was used to classify patients as having controlled (ACT 20-25) or uncontrolled (ACT 19) asthma. Frequency and statistical tests were used to assess the association between hospital admissions/exacerbations/emergency department (ED) visits and uncontrolled asthma; multivariate logistic regression was used to assess the association of uncontrolled asthma with clinical/demographic variables. Results: A total of 594 patients were included. Overall controlled-asthma prevalence was 43.4% (95% confidence interval [CI]: 39.0, 47.4). Patients with uncontrolled asthma were more likely to be women (adjusted odds ratio [aOR]: 1.85; p ¼ 0.003), non-white (aOR: 2.14; p < 0.001), obese (aOR: 1.71; p ¼ 0.036), to have a low monthly family income (aOR: 1.75; p ¼ 0.004), to have severe asthma (aOR:1.59; p ¼ 0.26), and, compared with patients with controlled asthma, to have a higher likelihood of asthma exacerbations (34.5% vs. 15.9%; p < 0.001), hospital admissions (6.9% vs. 3.1%; p ¼ 0.042), and ED visits (34.5% vs. 15.9%; p < 0.001) due to asthma. Conclusions: Even in specialist ambulatory services, fewer than half of patients were classified as having controlled asthma. The proportion of uncontrolled patients varied according to clinical and demographic variables.

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“…Certainly, the possibility of adding a LAMA instead of the classic controllers to low or moderate doses of ICSs in patients with moderate symptomatic asthma is supported by increasing evidence (Chung, 2015), mainly in patients suffering from fixed airflow obstruction (Lee et al, 2015). Tiotropium bromide as a once-aday add-on to a low-to medium-dose ICS may also be efficacious and well tolerated in adults with moderate uncontrolled asthma (Wang et al, 2019). However, the results of a recent systematic review and meta-analysis confirmed the usefulness of combining a LAMA with an ICS as maintenance therapy in patients aged $12 years with persistent uncontrolled asthma (Sobieraj et al, 2018a).…”

Section: F When Must An Inhaled Corticosteroid Be Added?mentioning

confidence: 99%