Enhanced persistence with tiotropium compared with other respiratory drugs in COPD.
BACKGROUND
Tiotropium is a once-daily inhaled anticholinergic maintenance treatment with demonstrated effectiveness in chronic obstructive pulmonary disease (COPD).


OBJECTIVE
To compare persistence of tiotropium-use with other inhaled respiratory drugs in COPD in current clinical practice.


METHODS
The PHARMO database includes, among others, drug-dispensing and hospital discharge records for 2> or = million subjects in the Netherlands. All probable COPD-patients were identified by new respiratory drug use (age >54 years) or COPD-hospitalisations. New users of tiotropium, ipratropium, long-acting beta-agonists (LABAs), or fixed combination of LABA and inhaled corticosteroids (LABA+ICS), in 1998-2003, were included in the study. Persistence was assessed quarterly during the first year of follow-up. Patients with a proportion of days covered (PDC) > or =80% were considered persistent. Persistence was analysed using generalised estimating equations model.


RESULTS
About 37% of new users of tiotropium continued treatment for 1 year, compared with 14% for ipratropium, 13% for LABA, and 17% for LABA+ICS. Multivariate analyses showed that tiotropium-users were 2-3 times more persistent with their therapy than patients using ipratropium (relative risk [RR]: 2.0; 95% confidence interval [CI]: 1.8-2.3), LABA (RR: 2.9; 95% CI: 2.4-3.6), or LABA+ICS (RR: 2.4; 95% CI: 2.1-2.8), respectively. Sub-analyses in patients with a prior hospitalisation for COPD showed that 1-year persistence rates were increased for all treatments (varying from 33% for patients using LABA+ICS to 61% for patients using tiotropium), while persistence with tiotropium was again 2-3 times higher compared with other treatments.


CONCLUSIONS
Persistence with tiotropium was higher compared to other inhaled respiratory drugs in COPD in clinical practice.
Breekveldt-Postma
Nancy S
NS
PHARMO Institute, Utrecht, The Netherlands.
Koerselman
Jeroen
J
Erkens
Joëlle A
JA
Lammers
Jan-Willem J
JW
Herings
Ron M C
RM
D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015331:Cohort Studies; D019992:Databases as Topic; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D010349:Patient Compliance; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000523:psychology; D012602:Scopolamine Derivatives / Q000008:administration & dosage* / Q000627:therapeutic use; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D005938:Glucocorticoids; D012602:Scopolamine Derivatives; D009241:Ipratropium; D000069447:Tiotropium Bromide