Evaluation of withdrawal of maintenance tiotropium in COPD

Adams, Sandra G.; Anzueto, Antonio; Briggs, Dick D.; Leimer, Inge; Kesten, Steven

doi:10.1016/j.rmed.2009.05.018

Cited by 18 publications

(11 citation statements)

References 23 publications

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“…The initial search identified 27 086 records, and 1378 were identified through other methods (Figure ). A total of 497 full papers were retrieved for further examination, and 132 papers reported 116 studies that met the inclusion criteria (Figure ) . Additional information was sought from the authors of 18 studies .…”

Section: Resultsmentioning

confidence: 99%

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The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

Page

Clifford

Potter

et al. 2016

Brit J Clinical Pharma

376

382

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AIMSDeprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not deprescribing is a safe, effective and feasible intervention to modify mortality and health outcomes in older adults. METHODSSpecified databases were searched from inception to February 2015. Two researchers independently screened all retrieved articles for inclusion, assessed study quality and extracted data. Data were pooled using RevMan v5.3. Eligible studies included those where older adults had at least one medication deprescribed. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, psychological and physical health outcomes, quality of life, and medication usage (e.g. successful deprescribing, number of medications prescribed, potentially inappropriate medication use). RESULTSA total of 132 papers met the inclusion criteria, which included 34 143 participants aged 73.8 ± 5.4 years. In nonrandomized studies, deprescribing polypharmacy was shown to significantly decrease mortality (OR 0.32, 95% CI: 0.17-0.60). However, this was not statistically significant in the randomized studies (OR 0.82, 95% CI 0.61-1.11). Subgroup analysis revealed patientspecific interventions to deprescribe demonstrated a significant reduction in mortality (OR 0.62, 95% CI 0.43-0.88). However, generalized educational programmes did not change mortality (OR 1.21, 95% CI 0.86-1.69). CONCLUSIONSAlthough nonrandomized data suggested that deprescribing reduces mortality, deprescribing was not shown to alter mortality in randomized studies. Mortality was significantly reduced when applying patient-specific interventions to deprescribe in randomized studies. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Polypharmacy in older adults is correlated to poor health outcomes.• Deprescribing is one proposed intervention to reduce the harm associated with polypharmacy.• Limited evidence is available to support deprescribing as an intervention. British Journal of Clinical PharmacologyBr J Clin Pharmacol (2016) 82 583-623 583

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Section: Resultsmentioning

confidence: 99%

“…The remaining 68% of studies all had unclear or high risk of bias. Industry funded ten studies that were included in this review, which was declared in the paper in each case [31,41,42,57,66,81,97,114,118,135].…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

Page

Clifford

Potter

et al. 2016

Brit J Clinical Pharma

376

382

View full text Add to dashboard Cite

show abstract

“…713 patients out of the 921 enrolled in this study underwent a pre-planned withdrawal of tiotropium. A worsening of SGRQ, although not significant, was observed [69].…”

Section: Tiotropiummentioning

confidence: 76%

Long-acting bronchodilators improve Health Related Quality of Life in patients with COPD

Braido

Baiardini

Cazzola

et al. 2013

Respiratory Medicine

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“…1. El tratamiento broncodilatador ejerce su efecto solamente durante su administración, por lo que es muy probable que la retirada de un broncodilatador o su sustitución por otro de menor potencia broncodilatadora o menor duración de acción produzca un empeoramiento funcional y/o sintomático 234 realiza en el asma. No se recomienda dejar a estos pacientes con tratamiento con BDLD sin CI.…”

Section: Adecuación Del Tratamiento Durante El Seguimientounclassified

Guía de Práctica Clínica para el Diagnóstico y Tratamiento de Pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC) - Guía Española de la EPOC (GesEPOC)

GesEPOC¹

2012

Archivos de Bronconeumología

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Evaluation of withdrawal of maintenance tiotropium in COPD

Abstract: The withdrawal of tiotropium results in worsening of COPD over a three-week interval. There was no evidence of a rebound effect in response to tiotropium withdrawal.

Cited by 18 publications

References 23 publications

The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

Long-acting bronchodilators improve Health Related Quality of Life in patients with COPD

Guía de Práctica Clínica para el Diagnóstico y Tratamiento de Pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC) - Guía Española de la EPOC (GesEPOC)

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