Tiotropium for treatment of stable COPD: a meta-analysis of clinically relevant outcomes.
OBJECTIVE
To systematically review recent evidence on the effectiveness of tiotropium versus placebo, ipratropium, and long-acting β(2) agonists on outcomes relevant to patients with stable COPD, including health-related quality of life, dyspnea, exacerbations and hospitalizations.


METHODS
Our inclusion criteria for trials were: ≥ 12 weeks; compared tiotropium to placebo, ipratropium, or long-acting β agonists; patients ≥ 40 y old and with stable COPD. Sixteen trials (16,301 patients) met the inclusion criteria.


RESULTS
Tiotropium improved health-related quality of life (measured with St George's Respiratory Questionnaire) compared to placebo (odds ratio [OR] 1.61, 95% CI 1.38-1.88, P < .001) and ipratropium (OR 2.03, 95% CI 1.34-3.07, P = .001). Tiotropium also improved dyspnea (measured with the Transitional Dyspnea Index) compared to placebo (OR 1.96, 95% CI 1.58-2.44, P < .001) and ipratropium (OR 2.10, 95% CI 1.28-3.44, P = .003). Tiotropium decreased the likelihood of an exacerbation (OR 0.83, 95% CI 0.72-0.94, P = .004) and related hospitalizations (OR 0.89, 95% CI 0.80-0.98, P = .02) but not serious adverse events (OR 1.06, 95% CI 0.97-1.17, P = .19), compared to placebo. The cumulative incidence of dry mouth was 7.4% with tiotropium, compared to 3.9% with ipratropium, 1.6% with salmeterol, and 2.0% with placebo.


CONCLUSIONS
In stable COPD, tiotropium showed superior efficacy in improving quality of life and dyspnea, compared to placebo and ipratropium. However, tiotropium's differences with salmeterol were less clear.
Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom, UK. a.yohannes@mmu.ac.uk
Abebaw Mengistu
AM
Yohannes
Thomas George
TG
Willgoss
Jørgen
J
Vestbo
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D009241:Ipratropium / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests; D012602:Scopolamine Derivatives / Q000627:therapeutic use*; D000069447:Tiotropium Bromide
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D012602:Scopolamine Derivatives; D009241:Ipratropium; D000069447:Tiotropium Bromide