Dixon, AE and Subramanian, M and DeSarno, M and Black, K and Lane, L and Holguin, F
(2015)
A pilot randomized controlled trial of pioglitazone for the treatment of poorly controlled asthma in obesity.
Respiratory Research, 16 (1).
ISSN 1465-9921
Abstract
Background: Obese asthmatics tend to have poorly controlled asthma, and resistance to standard asthma controller medications. The purpose of this study was to determine the efficacy of pioglitazone, an anti-diabetic medication which can alter circulating adipokines and have direct effects on asthmatic inflammation, in the treatment of asthma in obesity. Methods: A two-center, 12-week, randomized, placebo-controlled, double-blinded trial. Treatments were randomly assigned with concealment of allocation. The primary outcome was difference in change in airway reactivity between participants assigned to pioglitazone versus placebo at 12weeks. Results: Twenty-three participants were randomized to treatment, 19 completed the study. Median airway reactivity, measured by PC20 to methacholine was 1.99 (IQR 3.08) and 1.60 (5.91) mg/ml in placebo and pioglitazone group at baseline, and 2.37 (15.22) and 5.08 (7.42) mg/ml after 12weeks, p=0.38. There was no difference in exhaled nitric oxide, asthma control or lung function between treatment groups over the 12week trial. Participants assigned to pioglitazone gained a significant amount more weight than those assigned to placebo (pioglitazone group mean weight 113.6, CI 94.5-132.7kg at randomization and 115.9, CI 96.9-135.1 at 12weeks; placebo mean weight 127.5, CI 108.4 - 146.6kg at randomization and 124.5, CI 105.4 - 143.6kg at 12weeks; p=0.04). Conclusions: This pilot study suggests limited efficacy for pioglitazone in the treatment of poorly controlled asthma in obesity, and also the potential for harm, given the weight gain in those assigned to active treatment, and the association between increased weight and worse outcomes in asthma. Trial Registration: Clinicaltrials.gov (NCT00634036)
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