Pneumologie 2019; 73(S 01)
DOI: 10.1055/s-0039-1678042
Posterbegehung (P05) – Sektion Klinische Pneumologie
Asthma 2019
Georg Thieme Verlag KG Stuttgart · New York

Tiotropium provides greater improvements in FEV1 than leukotriene receptor antagonists as add-on to ICS in adults with asthma: a systematic review

on behalf of
E Beck
1   Institut für Gesundheitsförderung, Rüdersdorf, Brandenburg,
,
A Kaplan
2   Family Physician Airways Group of Canada, University of Toronto, Family Physician Airways Group of Canada
,
JM Fitzgerald
3   The Lung Centre, Gordon and Leslie Diamond Health Care Centre; University of British Columbia
,
GE Azzi
4   Ta Respiratory Diseases, Boehringer Ingelheim Pharma GmbH & Co. Kg
,
M Engel
4   Ta Respiratory Diseases, Boehringer Ingelheim Pharma GmbH & Co. Kg
,
R Buhl
5   Universitätsmedizin Mainz, Med. Klinik III, Schwerpunkt Pneumologie
› Author Affiliations
Further Information

Publication History

Publication Date:
19 February 2019 (online)

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Introduction Adults with asthma who are not controlled on inhaled corticosteroids (ICS) may be treated with tiotropium or leukotriene receptor antagonists (LTRAs), such as montelukast or zafirlukast, as add-on therapies.

Aim In this systematic literature search we compared the efficacy of tiotropium and LTRAs as add-on to ICS in adult patients with asthma.

Methods We searched PubMed for publications that compared tiotropium or LTRAs with placebo, as add-on to ICS, for at least 4 weeks, reporting change in forced expiratory volume in 1 second (FEV1) or number of exacerbations requiring oral corticosteroids (OCS).

Results The systematic literature search identified four relevant publications: a tiotropium meta-analysis, two montelukast randomised controlled trials (RCTs) and a zafirlukast RCT. Overall, tiotropium had a greater effect on FEV1 than LTRAs. Mean change in FEV1 from baseline versus placebo was 0.14 – 0.19 L with tiotropium, 0.03 – 0.10 L with montelukast and 0.12 L with zafirlukast. Exacerbations requiring OCS were significantly reduced with tiotropium, but not montelukast, versus placebo. Exacerbations requiring additional controller therapy (70% of therapies were OCS) were significantly reduced with zafirlukast versus placebo.

Conclusion This systematic literature review suggests that tiotropium provides greater improvements in FEV1 than montelukast or zafirlukast as an add-on to ICS in adults with asthma.