Mometasone, Tiotropium Do Not Top Placebo in Mild Asthma

For patients with mild asthma with a low sputum eosinophil level, outcomes do not differ significantly for mometasone or tiotropium versus placebo; and budesonide-formoterol is superior to albuterol for prevention of asthma exacerbations, according to two studies published online May 19 in the New England Journal of Medicine. The research was published to coincide with the American Thoracic Society 2019 International Conference, held from May 17 to 22 in Dallas.

Stephen C. Lazarus, M.D., from the University of California in Los Angeles, and colleagues randomly assigned 295 patients aged 12 years or older with mild, persistent asthma to receive either mometasone, tiotropium, or placebo. The researchers found that 73 percent of the patients had a low eosinophil level and 59 percent of these patients had a differential response to a trial agent. No significant difference was seen in the response to mometasone or tiotropium versus placebo.

Richard Beasley, D.Sc., from the Medical Research Institute of New Zealand in Wellington, and colleagues conducted a 52-week open-label study involving adults with mild asthma. A total of 668 patients were randomly assigned to either albuterol, budesonide plus as-needed albuterol, or budesonide-formoterol. The researchers found that the annualized exacerbation rate for the budesonide-formoterol group was lower than the rate for the albuterol group (absolute rate, 0.195 versus 0.400; relative rate, 0.49; 95 percent confidence interval, 0.33 to 0.72; P < 0.001) and was not significantly different from the rate for the budesonide maintenance group (absolute rate, 0.195 versus 0.175; relative risk 1.12; 95 percent confidence interval, 0.70 to 1.79; P = 0.65).

"Given all these results, we should carefully review the current guideline recommendations for treating mild asthma," writes the author of an accompanying editorial.

In the Lazarus study, study drugs and placebos were provided by pharmaceutical companies. The Beasley study was funded by AstraZeneca.

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