title: The efficacy and safety of tiotropium in Chinese patients with stable chronic obstructive pulmonary disease: a meta-analysis.
abstract: OBJECTIVE
  Tiotropium is the only long-acting inhaled anticholinergic bronchodilator currently available in China, but information about its clinical effect in this population is limited. This meta-analysis assessed the efficacy and safety of tiotropium in Chinese patients with stable COPD.
  
  
  METHODS
  An electronic search of the literature was undertaken to identify randomized controlled trials (RCTs) of tiotropium in Chinese patients, which were then assessed for inclusion in a meta-analysis. The efficacy and safety of tiotropium was compared with placebo and ipratropium, using the outcomes of FEV(1), FEV(1)%, symptoms, frequency of exacerbations, adverse events and safety.
  
  
  RESULTS
  Eleven RCTs recruiting 1006 patients were included in the meta-analysis. Compared with both placebo and ipratropium, tiotropium significantly improved FEV(1)[weighted mean difference (WMD) = 304 mL, 95% CI 271-337], FEV(1)% (WMD = 8.35%, 95% CI 5.40-11.31) and symptoms [relative risk (RR) = 2.00, 95% CI 1.61-2.49]. Tiotropium significantly reduced the risk of exacerbations (RR = 0.07, 95% CI 0.01-0.54) compared with placebo, and there was a non-significant reduction in the risk of exacerbations compared with ipratropium (RR = 0.70, 95% CI 0.13-3.75). Tiotropium was well tolerated with a similar safety profile to placebo and ipratropium (RR = 1.16, 95% CI 0.76-1.77, P = 0.49).
  
  
  CONCLUSIONS
  Tiotropium improved pulmonary function and symptoms, reduced exacerbations and was well tolerated and safe. On the basis of its efficacy and safety profile, tiotropium appears to be a reasonable first-line choice for the management of Chinese patients with stable COPD. Additional long-term RCTs are required to further evaluate the efficacy and safety of tiotropium.
authors.affiliation: Department of Internal Medicine, Macau University of Science and Technology, Avenida Wai Long, Macau, China. qbwu@must.edu.mo
authors.forename: Qibiao
authors.initials: Q
authors.lastname: Wu
authors.forename: Guochun
authors.initials: G
authors.lastname: Li
authors.forename: Wun I
authors.initials: WI
authors.lastname: Lei
authors.forename: Xiqiao
authors.initials: X
authors.lastname: Zhou
mesh_terms: D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002681:China; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008168:Lung / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000208:ethnology* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D012602:Scopolamine Derivatives / Q000009:adverse effects / Q000627:therapeutic use*; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D000069447:Tiotropium Bromide