A Randomized, Noninferiority Trial Comparing ICS thorn LABA with ICS plus LABA plus LAMA in Asthma-COPD Overlap (ACO) Treatment: The ACO Treatment with Optimal Medications (ATOMIC) Study
- 주제(키워드) Asthma-COPD overlap , ICS , LABA , LAMA , Triple therapy
- 주제(기타) Allergy
- 주제(기타) Immunology
- 설명문(일반) [Park, So-Young; Kim, Solmi; Kim, Tae-Bum] Univ Ulsan, Asan Med Ctr, Dept Allergy & Clin Immunol, Coll Med, 88 Olymp Ro 43 Gil, Seoul 05505, South Korea; [Park, So-Young] Konkuk Univ, Dept Internal Med, Sch Med, Div Pulm Allergy & Crit Care Med, Seoul, South Korea; [Kim, Jung-Hyun] Armed Forces Capital Hosp, Dept Internal Med, Div Allergy & Clin Immunol, Seongnam, South Korea; [Kim, Sae-Hoon] Seoul Natl Univ, Dept Internal Med, Div Allergy & Clin Immunol, Bundang Hosp, Seongnam, South Korea; [Lee, Taehoon] Univ Ulsan, Ulsan Univ Hosp, Dept Internal Med, Coll Med, Ulsan, South Korea; [Yoon, Sun-Young] Chungnam Natl Univ, Chungnam Natl Univ Hosp, Dept Internal Med, Sch Med, Daejeon, South Korea; [Kim, Min-Hye] Ewha Womans Univ, Dept Internal Med, Coll Med, Seoul, South Korea; [Moon, Ji-Yong] Hanyang Univ, Dept Internal Med, Coll Med, Seoul, South Korea; [Yang, Min-Suk] Seoul Metropolitan Govt Seoul Natl Univ Boramae M, Dept Internal Med, Seoul, South Korea; [Jung, Jae-Woo] Chung Ang Univ, Dept Internal Med, Coll Med, Seoul, South Korea; [Kim, Joo-Hee] Hallym Univ, Dept Internal Med, Sacred Heart Hosp, Anyang, South Korea; [Choi, Jeong-Hee] Hallym Univ, Dept Pulmonol & Allergy, Dongtan Sacred Heart Hosp, Hwaseong, South Korea; [Choi, Jeong-Hee] Hallym Univ, Allergy & Clin Immunol Res Ctr, Coll Med, Chunchon, South Korea; [Park, Chan Sun] Inje Univ, Dept Internal Med, Haeundae Paik Hosp, Busan, South Korea; [Kim, Sujeong] Kyungpook Natl Univ, Dept Internal Med, Sch Med, Daegu, South Korea; [Lee, Jaechun] Jeju Natl Univ, Dept Internal Med, Sch Med, Jeju, South Korea; [Kwon, Jae-Woo] Kangwon Natl Univ, Dept Allergy & Clin Immunol, Sch Med, Chunchon, South Korea; [Hur, Gyu Young] Korea Univ, Dept Internal Med, Coll Med, Seoul, South Korea; [Kim, Sang-Ha] Yonsei Univ, Dept Internal Med, Wonju Coll Med, Wonju, South Korea; [Kim, Hee-Kyoo] Kosin Univ, Dept Internal Med, Coll Med, Busan, South Korea; [Shin, Yoo Seob] Ajou Univ, Dept Allergy & Clin Immunol, Sch Med, Suwon, South Korea; [Kim, Sang-Hoon] Eulji Univ, Dept Internal Med, Coll Med, Seoul, South Korea; [Nam, Young-Hee] Dept Internal Med, Dong A Univ, Coll Med, Busan, South Korea; [Jang, An-Soo] Soonchunhyang Univ, Sch Med, Dept Internal Med, Bucheon Hosp, Bucheon, South Korea; [Park, Seo Young] Univ Ulsan, Asan Med Ctr, Dept Clin Epidemiol & Biostat, Coll Med, Seoul, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 ELSEVIER
- 발행년도 2021
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000181508
- 본문언어 영어
- Published As http://dx.doi.org/10.1016/j.jaip.2020.09.066
초록/요약
BACKGROUND: Current guidelines for the treatment of asthma and chronic obstructive pulmonary disease overlap (ACO) recommend initial treatment using inhaled corticosteroids (ICSs) plus 1 or more bronchodilators. OBJECTIVE: To clarify which therapeutic effect is better between the ICS D long-acting beta(2) agonist (LABA) and ICS D LABA D long-acting muscarinic antagonist (LAMA) treatment in patients with ACO. METHODS: We conducted a multicenter, 48-week, randomized, noninferiority trial. Patients with ACO were enrolled if they were treated with a moderate to high dose of ICS D LABA. In total, 303 patients were involved in the present trial, with 149 receiving ICS D LABA D LAMA. The primary end point was the time to first exacerbation. Secondary outcomes included changes in FEV1, forced vital capacity, FEV1/forced vital capacity ratio, asthma control, blood eosinophil count, and fractional exhaled nitric oxide. RESULTS: In the ICS D LABA treatment group, 29 of 154 patients (18.83%) experienced exacerbation, whereas 28 of 149 patients (18.79%) experienced exacerbation in the ICS D LABA D LAMA treatment group. The results of this noninferiority study were ultimately inconclusive (hazard ratio, 1.1; 95% CI, 0.66-1.84). However, the patients treated with the addition of LAMA showed significant improvements in FEV1 and forced vital capacity (P <.001). Asthma control did not improve in either group. CONCLUSIONS: Although this study was unable to conclude that ICS D LABA treatment is not inferior to ICS D LABA D LAMA in terms of exacerbation, it is obvious that the ICS D LABADLAMA treatment group had improved lung function in ACO. (C) 2020 American Academy of Allergy, Asthma & Immunology
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