The effects of theophylline on hospital admissions and exacerbations in COPD patients: audit data from the Bavarian disease management program.
BACKGROUND
Theophylline is often used to treat chronic obstructive pulmonary disease (COPD). Current evidence leaves the effectiveness and safety of this drug open to question. Thus, we evaluated the effectiveness of theophylline on the rate of hospitalizations and disease exacerbations by examining routine data from the ambulatory disease management program for COPD in the German state of Bavaria.


METHODS
Data sets from a total of 30 330 patients were examined. Logistic regression models were used to calculate propensity scores that controlled for baseline characteristics. These propensity scores, in turn, were used to create comparable patient groups, which were observed for a median follow-up time of 9 quarters (the theophylline group) and 10 quarters (the control group).


RESULTS
1496 patients with first prescription of theophylline were matched with 1496 patients with no record of theophylline treatment. 1. The probability of suffering an exacerbation during the period of observation, was 33.5% for the control group and 43.4% for the theophylline group [hazard ratio (HR) 1.41; 95% confidence interval (CI) 1.24 to 1.60], yielding a number needed to harm (NNH) of 11 (95% CI 7.7 to 20.9). The probability for hospitalization was 11.4% for the control group and 17.4% of the theophylline group (HR 1.61; 95% CI 1.29 to 2.01), yielding a NNH of 17 (95%CI 11.0-34.5).


CONCLUSIONS
Treatment with theophylline is associated with an elevated incidence of exacerbations and hospitalizations. The therapeutic value of this drug should be reconsidered and investigated in further studies.
Institute of General Practice, Klinikum rechts der Isar der TU M¨nchen, National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Institute of Medical Biometrics, Epidemiology, and Medical Informatics (IMBEI) of the Saarland University, Homburg/Saar, F. Fexer and E. Donnachie share primary authorship of this article.
Johannes
J
Fexer
Ewan
E
Donnachie
Antonius
A
Schneider
Stefan
S
Wagenpfeil
Manfred
M
Keller
Frank
F
Hofmann
Michael
M
Mehring
D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008485:Medical Audit; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology*; D012008:Recurrence; D012307:Risk Factors; D013806:Theophylline / Q000627:therapeutic use*
D001993:Bronchodilator Agents; D013806:Theophylline