Effect of tiotropium on COPD exacerbations: A systematic review.
Exacerbation frequency is related to disease progression, quality of life, and prognosis in COPD. Earlier diagnosis, along with interventions aimed at preventing exacerbations and delaying progression, may help reduce the global burden of disease. Long-acting inhaled bronchodilators are effective at maintaining symptom relief and are recommended as first-choice therapy for more symptomatic patients and those at risk of exacerbation.



As prevention of exacerbations is a priority goal in COPD management and a number of different long-acting bronchodilators are available, we conducted a systematic review of exacerbation data from randomized controlled trials (published January 2000 to May 2014) comparing the effect of tiotropium versus placebo and/or other maintenance therapies.



Exacerbations were a primary endpoint in 12 publications (five studies: four comparing tiotropium with placebo; one with active comparator) and a secondary endpoint in 17 publications (seven studies: six comparing tiotropium with placebo; one with active comparator). Overall, tiotropium was associated with a longer time to first exacerbation event and fewer exacerbations (including severe exacerbations/hospitalizations) compared with placebo and long-acting β2-agonists. Tiotropium also showed similar efficacy to glycopyrronium and a fixed long-acting muscarinic antagonist/long-acting β2-agonist combination (glycopyrronium/indacaterol), although not all studies were powered to demonstrate differences in exacerbation outcomes. Exacerbation outcomes were comparable with both formulations of tiotropium (HandiHaler(®) 18 μg/Respimat(®) 5 μg).



The results of this comprehensive systematic review demonstrate tiotropium is beneficial in reducing exacerbation risk versus placebo or other maintenance treatments.
Royal Devon and Exeter Hospital, University of Exeter Medical School, Exeter, UK. Electronic address: d.halpin@nhs.net.
David M G
DM
Halpin
Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipp University of Marburg, Member of the German Center for Lung Research, Marburg, Germany.
Claus
C
Vogelmeier
Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany.
Michael P
MP
Pieper
Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany.
Norbert
N
Metzdorf
Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany.
Frank
F
Richard
Department of Medicine, Division of Pulmonary Diseases/Critical Care Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; The South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital Division, San Antonio, TX, USA.
Antonio
A
Anzueto
D000280:Administration, Inhalation; D001993:Bronchodilator Agents / Q000494:pharmacology* / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D006024:Glycopyrrolate / Q000494:pharmacology; D006801:Humans; D007189:Indans / Q000494:pharmacology; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D015363:Quinolones / Q000494:pharmacology; D016032:Randomized Controlled Trials as Topic; D000069447:Tiotropium Bromide / Q000008:administration & dosage / Q000494:pharmacology*
D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D007189:Indans; D018727:Muscarinic Antagonists; D015363:Quinolones; C510790:indacaterol; D006024:Glycopyrrolate; D000069447:Tiotropium Bromide
Anticholinergic; Antimuscarinic; COPD; Long-acting muscarinic antagonist