The impact of Tiotropium on Mortality and Exacerbations when added to Inhaled Corticosteroids and Long-Acting Beta-Agonist therapy in COPD.
Chest. 2011 Jul 28;
Authors: Short PM, Williamson PA, Elder DH, Lipworth SI, Schembri S, Lipworth BJ
Abstract BACKGROUND: Tiotropium (Tio) has been shown to improve lung function, quality of life and exacerbations and reduce mortality when compared to placebo in COPD. It remains unclear if benefits are seen when tiotropium is used in conjunction with inhaled corticosteroid (ICS) plus long-acting beta-agonists (LABA). METHODS: We performed a retrospective cohort study using a NHS database of COPD patients in Tayside Scotland, between 2001 and 2010 linked with databases regarding hospital admissions, pharmacy prescriptions and death registries. The impact of the addition of Tio to ICS+LABA therapy on all-cause mortality, hospital admissions due to respiratory disease and emergency oral corticosteroid bursts was evaluated. Adjusted Hazard ratios (HR) were calculated by Cox Regression after inclusion of the following covariates (cardiovascular and respiratory disease, diabetes, smoking, age, sex and deprivation index). RESULTS: 1857 patients were prescribed ICS+LABA+Tio and 996 were prescribed ICS+LABA. Mean follow- up was 4.65yrs. Adjusted HR for all-cause mortality for ICS+LABA+Tio versus ICS+LABA was 0.65 (95%CI 0.57-0.75) p<0.001. Adjusted HR for hospital admissions and oral corticosteroid bursts were 0.85 (95%CI 0.73-0.99) p=0.04 and 0.71 (95%CI 0.63-0.80) p<0.001. CONCLUSION: Our study suggests the addition of tiotropium to inhaled corticosteroids and LABA therapy may confer benefits in reducing all-cause mortality, hospital admissions and oral corticosteroid bursts in COPD patients. Triple therapy is widely used in real-life management of COPD with only limited scientific support. Our study supports the use of triple therapy in COPD and provides a platform for randomised controlled trials specifically addressing this topic.
PMID: 21799028 [PubMed - as supplied by publisher]