Improving FEV1 in Children With Asthma: Tiotropium Add-On to ICS vs LTRAs

This article is part of Pulmonology Advisor‘s coverage of the American Academy of Allergy, Asthma & Immunology annual meeting, taking place in San Francisco, California. Our staff will report on medical research related to asthma, allergy, and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI 2019.

SAN FRANCISCO — Tiotropium may be superior to leukotriene receptor antagonists (LTRAs) as an add-on therapy to an inhaled corticosteroid (ICS) for improving forced expiratory volume (FEV₁) in children and adolescents with asthma, according to research presented at the 2019 Annual Scientific Meeting of the American College of Allergy, Asthma &Immunology (AAAAI) held February 22-25 in San Francisco, California.

Investigators reviewed recent (post-July 2014) published manuscripts via PubMed that reported comparison analyses between LTRAs with placebo as add-on to ICS for ≥4 weeks in asthma patients between ages 5 and 18 years. Studies published before July 2014 were included in 2 systematic reviews. The researchers compared these data with data from tiotropium studies in pediatric patients with asthma.

A total of 2 systematic reviews with meta-analyses, including analyses of 35 trials and 5 studies, were included in the final analysis. In addition, 4 trials on tiotropium as add-on therapy were included in the study. Although variation existed in study designs, the researchers found 5 µg tiotropium to be superior over placebo for improving FEV₁ percent predicted when added to ICS (peak, 1.64%-6.52%; trough, 0.83%-4.44%).

Furthermore, 2.5 µg tiotropium was associated with greater improvements in FEV₁ (peak, 3.11%-7.70%; trough, 2.35%-5.05%) compared with LTRA (FEV₁ [peak/trough not specified] 0.73%-2.50%). The researchers reported that a similar percentage of patients across treatment groups experienced adverse events relative to placebo.

Potential limitations of the analysis included the variation in study designs and the lack of generalizability of the findings to adult patients.

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Reference

Goldstein S, Vogelberg C, Graham L, de la Hoz A, Kallsen K, Hamelmann EH. Tiotropium provides greater improvements in FEV than an LTRA as add-on to ICS in children and adolescents with asthma: a systematic review. Presented at: the Annual Meeting of the American Academy of Allergy, Asthma & Immunology; February 22-25, 2019; San Francisco, CA. Abstract 279.