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Free Content Add-on tiotropium versus step-up inhaled corticosteroid plus long-acting beta-2‐agonist in real-world patients with asthma

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Background:

A step-up approach (increasing inhaled corticosteroid [ICS] dose and/or add-on treatment) is recommended for asthma that is uncontrolled despite ICS plus long-acting beta-2‐agonist (LABA) combination treatment. Understanding the impact of different treatment options on health outcomes can help guide treatment decision-making.

Objective:

To compare the effectiveness of add-on tiotropium 1.25 µg (two puffs once daily) versus an increased ICS plus LABA dose in a real-world cohort of patients with asthma initiated on ICS plus LABA.

Methods:

De-identified data from patients ages ≥12 years and with asthma who were initiated on ICS plus LABA, and then had tiotropium added (Tio group; index date) or an ICS plus LABA dose increased (inc-ICS group; index date) were collected from two medical and pharmacy claims data bases (2014‐2018). To account for population/group differences, propensity score matching was performed. The primary end point was the exacerbation risk after the index date. Secondary end points included exacerbation rates 6 and 12 months postindex, health-care resource utilization, costs, and short-acting beta-2‐agonist (SABA) refills 12 months postindex.

Results:

Overall, 7857 patients (Tio group, 2619; inc-ICS group, 5238) were included. The exacerbation risk was 35% lower in the Tio group than in the inc-ICS group (hazard ratio 0.65 [95% confidence interval, 0.43‐0.99]; p = 0.044). Exacerbation rates in the Tio group also were significantly lower within 6 and 12 months postindex (64% and 73%, respectively). All-cause and asthma-related emergency department (ED) visits were 47% and 74% lower, respectively (p < 0.0001 for both), and all-cause and asthma-related hospitalizations were 48% (p < 0.01) and 76% (p < 0.001) lower, respectively, in the Tio group. Also, significantly fewer patients in the Tio group versus the inc-ICS group required SABA refills (56% versus 67%, p < 0.0001).

Conclusion:

Add-on tiotropium significantly decreased the risk and rate of exacerbations, decreased all-cause and asthma-related ED visits and hospitalizations, and reduced SABA refills compared with increasing the ICS plus LABA dose. The findings supported the use of add-on tiotropium for patients with uncontrolled asthma taking ICS plus LABA.

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Keywords: Emergency room; exacerbation; healthcare resource use; hospitalization; inhaled corticosteroid; long-acting β2-agonist; real-world study; short-acting β2-agonist; tiotropium; uncontrolled asthma

Document Type: Research Article

Affiliations: 1: From the Capital Allergy and Respiratory Disease Center, Sacramento, California; 2: Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, NorthShore University HealthSystem, Chicago, Illinois; 3: Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin, Madison, Wisconsin; 4: Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut; 5: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan; 6: eMAX Health, White Plains, New York; and 7: Allergy and Immunology, The Allergy and Asthma Center, East Providence, Rhode Island

Publication date: July 1, 2020

This article was made available online on May 15, 2020 as a Fast Track article with title: "Add-on tiotropium versus step-up inhaled corticosteroid plus long-acting beta-2–agonist in real-world patients with asthma".

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  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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