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
- Authors
- Park, So-Young; Kim, Solmi; Kim, Jung-Hyun; Kim, Sae-Hoon; Lee, Taehoon; Yoon, Sun-Young; Kim, Min-Hye; Moon, Ji-Yong; Yang, Min-Suk; Jung, Jae-Woo; Kim, Joo-Hee; Choi, Jeong-Hee; Park, Chan Sun; Kim, Sujeong; Lee, Jaechun; Kwon, Jae-Woo; Hur, Gyu Young; Kim, Sang-Ha; Kim, Hee-Kyoo; Shin, Yoo Seob; Kim, Sang-Hoon; Nam, Young-Hee; Jang, An-Soo; Park, Seo Young; Kim, Tae-Bum
- Issue Date
- 3월-2021
- Publisher
- ELSEVIER
- Keywords
- Asthma-COPD overlap; ICS; LABA; LAMA; Triple therapy
- Citation
- JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, v.9, no.3, pp.1304 - +
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
- Volume
- 9
- Number
- 3
- Start Page
- 1304
- End Page
- +
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/144707
- DOI
- 10.1016/j.jaip.2020.09.066
- ISSN
- 2213-2198
- Abstract
- 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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