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. 2025 Jan:236:107883.
doi: 10.1016/j.rmed.2024.107883. Epub 2024 Nov 29.

Factors influencing the prescription of add-on long-acting muscarinic antagonists in real-world asthma management: Insights from a national registry

Bilun Gemicioglu  1 , Derya Gokmen  2 , Ali Can  3 , Can Sevinc  4 , Ipek Kivilcim Oguzulgen  5 , Sadan Soyyigit  6 , Tugce Yakut  7 , Yavuz Havlucu  8 , Omur Aydin  9 , Gozde Koycu Buhari  10 , Zeynep Celebi Sozener  11 , Ismet Bulut  12 , Sengul Beyaz  13 , Cihan Orcen  14 , Secil Kepil Ozdemir  15 , Metin Keren  16 , Ebru Damadoglu  17 , Ayse Fusun Kalpaklioglu  18 , Ayse Baccioglu  19 , Sumeyra Alan Yalim  20 , Insu Yilmaz  21 , Ilkay Koca Kalkan  22 , Mehmet Atilla Uysal  23 , Elif Yelda Ozgun Niksarlioglu  24 , Ali Fuat Kalyoncu  25 , Gul Karakaya  26 , Muge Erbay  27 , Sibel Nayci  28 , Fatma Merve Tepetam  29 , Asli Gelincik  30 , Hulya Dirol  31 , Ozlem Goksel  32 , Selen Karaoglanoglu  33 , Ferda Oner Erkekol  34 , Sacide Rana Isik  35 , Fusun Yildiz  36 , Yasemin Yavuz  37 , Dilek Karadogan  38 , Nurgul Bozkurt  39 , Ummuhan Seker  40 , Ilknur Basyigit  41 , Serap Argun Baris  42 , Elif Yilmazel Ucar  43 , Tuba Erdogan  44 , Mehmet Polatli  45 , Dane Ediger  46 , Fatma Esra Gunaydin  47 , Murat Turk  48 , Leyla Pur  49 , Zeynep Yegin Katran  50 , Yonca Sekibag  51 , Enes Furkan Aykac  52 , Dilsad Mungan  53 , Ozcan Gul  54 , Ali Cengiz  55 , Bulent Akkurt  56 , Seyma Ozden  57 , Semra Demir  58 , Derya Unal  59 , Ayse Feyza Aslan  60 , Reyhan Gumusburun  61 , Gulhan Bogatekin  62 , Hatice Serpil Akten  63 , Sinem Inan  64 , Munevver Erdinc  65 , Aliye Candan Ogus  66 , Murat Kavas  67 , Demet Polat Yulug  68 , Mehmet Erdem Cakmak  69 , Saltuk Bugra Kaya  70 , Gulistan Alpagat  71 , Eylem Sercan Ozgur  72 , Oguz Uzun  73 , Sule Tas Gulen  74 , Gulseren Pekbak  75 , Deniz Kizilirmak  76 , Halil Donmez  77 , Bahar Arslan  78 , Gulden Pacaci Cetin  79 , Bilge Yilmaz Kara  80 , Adile Berna Dursun  81 , Gulden Pasaoglu Karakis  82 , Resat Kendirlinan  83 , Ayse Bilge Ozturk  84 , Gokcen Omeroglu Simsek  85 , Oznur Abadoglu  86 , Pamir Cerci  87 , Taskin Yucel  88 , Irfan Yorulmaz  89 , Zahide Ciler Tezcaner  90 , Emel Cadalli Tatar  91 , Ahmet Emre Suslu  92 , Serdar Ozer  93 , Engin Dursun  94 , Arzu Yorgancioglu  95 , Gülfem Elif Çelik  96
Affiliations

Factors influencing the prescription of add-on long-acting muscarinic antagonists in real-world asthma management: Insights from a national registry

Bilun Gemicioglu et al. Respir Med. 2025 Jan.

Abstract

Current guidelines recommend adding long-acting muscarinic antagonists (LAMAs) in patients with uncontrolled asthma, despite the use of moderate to high doses of inhaled steroid-long-acting beta agonists (ICS/LABA). This study aims to analyze the factors related to the prescription of add-on LAMA in clinical practice for asthma patients, shedding light on physicians' preferences. This study included adult asthma patients on add-on LAMA and ICS/LABA monitored for at least one year in a national registry comprising 2053 asthmatics. Patients' characteristics and disease profiles were analyzed to identify factors associated with the prescription of add-on LAMA across the entire cohort. A comparative analysis was performed among three groups: MART (ICS/formoterol as a maintenance and reliever therapy) plus LAMA, Conventional (ICS/LABA as a maintenance and short-acting beta agonist as reliever) plus LAMA and Triple (ICS/LABA/LAMA single inhaler). LAMAs were added to ICS/LABA in 11.7 % of patients in the national registry. Logistic regression analysis revealed that older age, low FEV1 (%), Asthma Control Test (ACT) scores less than 20, and severe exacerbation were the main factors influencing the initiation of LAMA in our registry. However, demographic characteristics of asthma, control status, pulmonary function test results were similar among the three groups of LAMA users (p > 0.05). Physicians used LAMAs without phenotyping based on allergic status or eosinophil levels (p > 0.05). Mepolizumab was added after LAMA in all patients, while omalizumab was initiated before LAMA in 16.9 % of the patients receiving LAMA along with biologics. Add-on LAMAs were predominantly prescribed for older, uncontrolled, and exacerbated asthma patients with low FEV1.

Keywords: Add-on LAMA; Antimuscarinics; Asthma management; Long-acting muscarinic antagonists; MART; Triple therapies.

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Conflict of interest statement

Declaration of competing interest Gemicioglu B report honoraria to her instutition from GSK, AstraZeneca, Abdi Ibrahim, Deva and grant to her institution for being in advisory board of GSK and Abdi Ibrahim not related to the study. Oguzulgen IK report honoraria and grants from GSK, Chiesi, AstraZeneca, Abdi Ibrahim, Deva and Novartis. Not related to the study. Mungan D, Yorgancioglu A and Celik GE report honoraria from GSK nor related to the study. Other authors have no conflict of interest.

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