Background Exacerbations are a defining outcome of chronic obstructive pulmonary disease (COPD). We evaluated the effect of tiotropium on COPD exacerbations and related hospitalizations among patients from the USA enrolled in clinical trials. Methods Data were pooled from six randomized, double-blind, placebo-controlled trials (6 to ≥12 months' duration) of tiotropium in patients with COPD. Exacerbations were defined retrospectively as an increase in or new onset of >1 respiratory symptom lasting for ≥3 days and requiring treatment with systemic corticosteroids and/or antibiotics. Time to first exacerbation or hospitalization and exacerbation rates were analyzed at 6 months, and at 1 year for studies ≥1 year. Results In total, 4355 patients (tiotropium, 2268, placebo, 2087; mean age 66.5 years; forced expiratory volume in 1 s [FEV1] 1.03 L [35.5% predicted]) were analyzed at 6 months and 2455 at 1 year (tiotropium 1317, placebo 1138; mean age 65.5 years; FEV 1 1.03 L [37.0% predicted]). Tiotropium delayed time to first exacerbation or first hospitalized exacerbation at 6 months (hazard ratios [HRs], 0.80, 0.65, respectively; p < 0.001 vs placebo) and 1 year (HRs, 0.73 and 0.55; p < 0.001 vs placebo) and reduced exacerbation rates and hospitalization rates (6 months: HRs, 0.79, 0.64; 1 year: HRs, 0.78, 0.56, respectively; all p < 0.01 vs placebo). Tiotropium significantly reduced exacerbations, irrespective of inhaled corticosteroid use at baseline. Tiotropium was not associated with an increased risk of cardiac-related events. Conclusions Tiotropium significantly reduced the risk and rates of exacerbations and hospitalizations among US patients with COPD.
Bibliographical noteFunding Information:
Antonio Anzueto, MD has participated as a speaker in scientific meetings or courses organized and financed by various pharmaceutical companies, including AstraZeneca, Boehringer Ingelheim, Bayer-Schering Pharma, Pfizer, and GlaxoSmithKline (GSK). He has been a consultant for AstraZeneca, Boehringer Ingelheim, Pfizer, GSK, and Bayer-Schering Pharma. Professor Anzueto has been the principal investigator in receipt of research grants, and the University of Texas Health Science Center at San Antonio was paid for participating in multicenter clinical trials sponsored by GSK, Lilly, and the National Institutes of Health.
Bartolome Celli, MD has been the principal investigator in receipt of research grants from GSK, Boehringer Ingelheim, Forest Medical, AstraZeneca, and Aeris. He has been part of an Advisory Board for GSK, Almirall, AstraZeneca, and Deep Breeze.
Marc Decramer, MD has been part of an Advisory Board for Boehringer Ingelheim, Pfizer, GSK, Novartis, Nycomed, Vectura, and Altana. He has performed consulting work for Boehringer Ingelheim, Pfizer, GSK, AstraZeneca, and Dompé. Professor Decramer has also received lecture fees from these companies (all amounting to <10,000 Euros/year). He receives a research grant of 45,000 Euros/year from AstraZeneca.
Dennis Niewoehner, MD has served on the advisory boards of GSK, AstraZeneca, and Merck, has received consulting fees from Novartis, Gilead, Boehringer, Pfizer, Forest Research, and Bayer Schering, and has received research grants from the National Institutes of Health.