- Low eosinophil levels (
- Mometasone did not correlate with clinical benefit vs long-acting muscarinic antagonist (LAMA) or placebo.
- Mometasone did help patients with sputum eosinophilia.
- Data do not support current treatment guidelines, but “provide clinical equipoise for a larger and longer study to compare inhaled glucocorticoids with other treatments,” authors say.
Why this matters
- How best to treat this population is unclear.
- 73% of patients had
- Of these, 130/221 (59%) had a differential response to study drug or placebo (95% CIs):
- Mometasone > placebo: 57% (48%-66%); and
- Placebo > mometasone: 43% (34%-52%; P=.14).
- Tiotropium > placebo: 60% (51%-68%); and
- Placebo > tiotropium: 40% (32%-49%; P=.029).
- Among patients with >2% eosinophils, response to mometasone was better vs to placebo.
- Results vulnerable to change because of missing data.
- Randomized multicenter 42-week double-blind crossover SIENA (n=295).
- Participants aged ≥12 years with mild persistent asthma randomly assigned to mometasone, tiotropium, or placebo.
- Outcome: responses among patients with
- Funding: NIH.
- Much imputation of data.
- Underpowered for age-related subgroup analyses.