University of Southern Denmark Safety and tolerability of once-daily tiotropium Respimat(®) as add-on to at least inhaled corticosteroids in adult patients with symptomatic asthma

Background: Tiotropium, a long-acting anticholinergic bronchodilator, has demonstrated efficacy and safety as add-on therapy to inhaled corticosteroids (ICS), with or without other maintenance therapies, in patients with symptomatic asthma. Objective: To evaluate safety and tolerability of tiotropium delivered via the Respimat device, compared with placebo, each as add-on to at least ICS therapy, in a pooled sample of adults with symptomatic asthma at different treatment steps. Methods: Data were pooled from seven Phase II and III, randomised, double-blind, parallel-group trials of 12e52 weeks’ treatment duration, which investigated once-daily tiotropium Respimat (5 mg, 2.5 mg) versus placebo as add-on to different background maintenance therapy including at least ICS. Adverse events (AEs) including serious AEs were assessed throughout treatment þ 30 days after the last dose of trial medication. Results: Of 3474 patients analysed, 2157 received tiotropium. The percentage of patients with AEs was comparable between treatment groups: tiotropium 5 mg, 60.8%; placebo 5 mg pool, 62.5%; tiotropium 2.5 mg, 57.1%; placebo 2.5 mg pool, 55.1%. Consistent with the disease profile, the most frequent AEs overall were asthma, decreased peak expiratory flow rate (both less frequent with tiotropium) and nasopharyngitis. Overall incidence of dry mouth, commonly associated with use of anticholinergics, was low: tiotropium 5 mg, 1.0%; placebo 5 mg pool, 0.5%; tiotropium 2.5 mg, 0.4%; placebo 2.5 mg pool, 0.5%. The percentage of cardiac disorder AEs was comparable between tiotropium and placebo: tiotropium 5 mg, 1.4%; placebo 5 mg pool, 1.4%; tiotropium 2.5 mg, 1.4%; placebo 2.5 mg pool, 1.1%. The proportions of patients with serious AEs were balanced across groups: tiotropium 5 mg, 4.0%; placebo 5 mg pool, 4.9%; tiotropium 2.5 mg, 2.0%; placebo 2.5 mg pool, 3.3%. Conclusion: Tiotropium Respimat demonstrated safety and tolerability comparable with those of placebo, as add-on to at least ICS therapy, at different treatment steps in adults with symptomatic asthma. © 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Ltd. This is an open access article u nder the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). R. Dahl et al. / Respiratory Medicine 118 (2016) 102e111 103