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A comparison of tiotropium, long-acting β2-agonists and leukotriene receptor antagonists on lung function and
Christian Vogelberg1, Stanley Goldstein2, LeRoy Graham3
1Department of Pediatric Pulmonology and Allergy, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany. christian.vogelberg@uniklinikum-dresden.de.
Insights
For children and adolescents with asthma uncontrolled by inhaled corticosteroids (ICS), long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) offer greater lung function improvement than leukotriene receptor antagonists (LTRAs). All treatments show comparable safety profiles.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Respiratory Medicine
Background:
- Asthma management in children and adolescents is challenging, with many experiencing uncontrolled symptoms despite inhaled corticosteroid (ICS) therapy.
- Selecting appropriate add-on pharmacotherapy for persistent asthma in this age group remains a clinical difficulty.
Purpose of the Study:
- To compare the efficacy and safety of long-acting beta2-agonists (LABAs), leukotriene receptor antagonists (LTRAs), and long-acting muscarinic antagonists (LAMAs) as add-on treatments to ICS in pediatric asthma patients (4-17 years).
Main Methods:
- A literature search identified 29 studies, including 21 randomized controlled trials (RCTs) of LABAs, 2 RCTs of LAMAs (tiotropium), and 4 RCTs of LTRAs (montelukast) as add-on therapy to ICS.
- Studies focused on efficacy (lung function, exacerbations) and safety (adverse events).
Main Results:
- Tiotropium (LAMA) and LABAs demonstrated greater lung function improvements compared to LTRAs when added to ICS.
- Tiotropium showed a reduced risk of exacerbations requiring oral corticosteroids.
- LABAs, LTRAs, and LAMAs exhibited comparable safety profiles to placebo regarding adverse events.
Conclusions:
- LABAs and LAMAs provide superior lung function improvements compared to LTRAs as add-on therapy to ICS in pediatric asthma.
- All three add-on options (LABAs, LTRAs, LAMAs) possess similar safety profiles in children and adolescents with asthma.
Abstract:
Diagnosing and treating asthma in paediatric patients remains challenging, with many children and adolescents remaining uncontrolled despite treatment. Selecting the most appropriate pharmacological treatment to add onto inhaled corticosteroids (ICS) in children and adolescents with asthma who remain symptomatic despite ICS can be difficult. This literature review compares the efficacy and safety of long-acting β2-agonists (LABAs), leukotriene receptor antagonists (LTRAs) and long-acting muscarinic antagonists (LAMAs) as add-on treatment to ICS in children and adolescents aged 4-17 years.A literature search identified a total of 29 studies that met the inclusion criteria, including 21 randomised controlled trials (RCTs) of LABAs versus placebo, two RCTs of LAMAs (tiotropium) versus placebo, and four RCTs of LTRA (montelukast), all as add-on to ICS. In these studies, tiotropium and LABAs provided greater improvements in lung function than LTRAs, when compared with placebo as add-on to ICS. Although exacerbation data were difficult to interpret, tiotropium reduced the risk of exacerbations requiring oral corticosteroids when added to ICS, with or without additional controllers. LABAs and LTRAs had a comparable risk of asthma exacerbations with placebo when added to ICS. When adverse events (AEs) or serious AEs were analysed, LABAs, montelukast and tiotropium had a comparable safety profile with placebo.In conclusion, this literature review provides an up-to-date overview of the efficacy and safety of LABAs, LTRAs and LAMAs as add-on to ICS in children and adolescents with asthma. Overall, tiotropium and LABAs have similar efficacy, and provide greater improvements in lung function than montelukast as add-on to ICS. All three controller options have comparable safety profiles.
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