Tiotropium for stable chronic obstructive pulmonary disease

Barr, R. Graham; Bourbeau, Jean; Camargo, Carlos A.

doi:10.1002/14651858.cd002876.pub2

Cited by 131 publications

(58 citation statements)

References 51 publications

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“…A Cochrane review of tiotropium found that it reduced COPD exacerbations and related hospitalisations compared to placebo or ipratropium. 9 Similar improvements were evident for quality-of-life and symptom scales. Increases in FEV 1 and forced vital capacity (FVC) from baseline were significantly larger with tiotropium than with placebo, ipratropium and LABAs.…”

Section: Which Long-acting Bronchodilator?mentioning

confidence: 64%

“…Changes in quality-of-life, symptom scales and spirometric indices also appeared clinically significant. 9 The Canadian Health Technology assessment concluded that LABAs did not demonstrate a significant advantage compared with either ipratropium or tiotropium in most functional outcome measures, and salmeterol was not as well tolerated as tiotropium. 10 A meta-analysis found that, compared to placebo, anticholinergics reduced severe exacerbations and respiratory deaths, whereas LABAs did not reduce severe exacerbations and may even have worsened disease control, as there was a two-fold increase in respiratory deaths.…”

Section: Peter Burrill Mrpharms Dippressci Fccp Ffpmmmentioning

confidence: 99%

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Drugs for COPD: current evidence

Burrill¹

2007

Prescriber

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EditorialR ecent evidence provides greater clarity on drug treatment choices in COPD. Treatment for COPD is focussed on minimising risk factors, improving symptoms, and preventing exacerbations. With the exception of smoking-cessation programmes for patients with early disease, home oxygen treatment for persistent hypoxaemia and lung-reduction surgery for selected patients with emphysema, no treatment has been shown to reduce mortality. Inhaled corticosteroidsPulmonary inflammation is prominent in COPD but inhaled corticosteroids (ICS) have not been shown to reduce the rate of decline of lung function. In a retrospective analysis, 1 ICS have been reported to reduce COPD-related mortality but this claim has been challenged by other analyses. 2,3 A double-blind, placebo-controlled trial designed to assess the effect of inhaled drugs on overall mortality has now been published. 4 The TOwards a Revolution in COPD Health (TORCH) study compared Seretide (salmeterol and fluticasone) with fluticasone alone (Flixotide), salmeterol alone (Serevent) and placebo over a three-year period. The risk of death in the Seretide, fluticasone and salmeterol groups did not differ significantly from that in the placebo group. Worryingly, the probability of having pneumonia was significantly greater in the fluticasone and Seretide groups than in the salmeterol or placebo groups, with a number needed to harm (NNH) of around 17.Some other recent evidence also suggests an increased risk of pneumonia with ICS use in COPD. 5 A nested case-control study found the use of ICS to be associated with an excess risk of pneumonia hospitalisation and of pneumonia hospitalisation leading to death within 30 days among older patients with COPD. The rate ratio for hospitalisation was greatest with the highest doses of ICS (equivalent to fluticasone 1000µg per day or more). ExacerbationsA subgroup analysis of the Inhaled Steroids in Obstructive Lung Disease in Europe (ISOLDE) study suggested that ICS might have benefit in reducing exacerbations by about 25 per cent. 6 This is somewhat difficult to interpret as 57 per cent of those allocated placebo had been using regular ICS and these were withdrawn before randomisation. Did this contribute to the exacerbation rate? Combination inhalersAlthough ICS alone are not licensed for use in COPD, the National Institute for Health and Clinical Excellence (NICE) recommends them as an option in more severe COPD with frequent exacerbations. 7 Combination inhalers containing ICS and a long-acting beta-agonist (LABA) are being increasingly prescribed. Does the combination add any extra benefit?The TRial of Inhaled STeroids ANd long-acting beta 2 -agonists (TRISTAN) compared Seretide with fluticasone alone, salmeterol alone and placebo. 8 Although Seretide reduced the rate of exacerbations by about 30 per cent compared to placebo, it was no different to fluticasone or salmeterol alone. It is also worth noting that in this trial 52 per cent of placebo patients had been using ICS and 38 per cent LABA before enrolment and ...

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Section: Which Long-acting Bronchodilator?mentioning

confidence: 64%

Section: Peter Burrill Mrpharms Dippressci Fccp Ffpmmmentioning

confidence: 99%

Drugs for COPD: current evidence

Burrill¹

2007

Prescriber

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“…Egyesek szerint a cardiovascularis mellékhatásokat növeli [33,34], mások szerint nem befolyásolja [35,36,37,38], sőt van olyan metaanalízis, amely szerint csökkenti [39].…”

Section: Metaanalízisek (2 Táblázat) Tiotropium Handihalerunclassified

Van-e cardiovascularis mellékhatásuk az inhalációs antikolinerg szereknek?

Nagy¹

2015

Orvosi Hetilap

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Az összefoglaló célja az inhalációs antikolinerg szerek cardiovascularis veszélyének tárgyalása krónikus obstruktív tü-dőbetegségben. A tiotropium-használat adatainak néhány metaanalízise felvetette ilyen mellékhatások (arrhythmia, angina, szívinfarktus stb.) fokozott lehetőségét. Az összefoglaló áttekinti a retrospektív adatbázis-feldolgozásokat, a randomizált kontrollcsoportos vizsgálatokat és a klinikai vizsgálatok metaanalíziseit. Az adatbázis-vizsgálatok eredményei inkonzisztensek. A legtöbb klinikai vizsgálatban a cardiovascularis mellékhatások incidenciája azonos volt az aktív kezelésű és a placebocsoportban, jellemzően azoknál a betegeknél is, akik előzőleg cardiovascularis betegségben szenvedtek. A metaanalízisekben kevés a bizonyíték vagy egyáltalán nincs arra nézve, hogy összefüggés van az antikolinergek és a cardiovascularis tünetek között. A szerző áttekinti a humán szív kolinergreceptor-altípusait és funkcióját, a szívműködés ezen receptorok útján történő autonóm szabályozását, ezek lehetséges szerepét és az inhalált antikolinerg szerek farmakokinetikai tulajdonságait. Megállapítja, hogy nincs bizonyíték az inhalációs antikolinerg szerek fokozott cardiovascularis ártalmára. Orv. Hetil., 2015, 156(31), 1246-1252. Kulcsszavak: krónikus obstruktív tüdőbetegség, inhalációs antikolinerg szerek, cardiovascularis szövődmények Are there cardiovascular adverse effects of inhaled anticholinergics?The purpose of this review is to discuss the cardiovascular risk associated with inhaled anticholinergics in chronic obstructive pulmonary disease. Several meta-analyses of data for tiotropium raised the possibility of an increased risk for arrhythmia, angina, myocardial infarction, etc. This review includes the data of retrospective studies of databases using databases, randomized controlled trials, and meta-analyses of clinical trials. The conclusions of studies were inconsistent. In most clinical trials the incidence of cardiovascular adverse events was similar in active treatment and placebo groups, especially in patients with previous cardiovascular diseases. Considering meta-analyses, there is little, if any, evidence for the association between anticholinergics and the development of cardiovascular symptoms. The author discusses the presence and function of cholinergic receptor subtypes in human heart, and cardiac functions controlled by the autonomic nervous system via these receptors, their possible role, and pharmacokinetic properties of inhaled anticholinergics. The author concludes that it is not possible to fi nd evidence of increased cardiovascular harm of inhaled anticholinergics.Keywords: chronic obstructive pulmonary disease, inhaled anticholinergics, adverse cardiovascular events Nagy, L. B. [Are there cardiovascular adverse effects of inhaled anticholinergics?]. Orv. Hetil., 2015, 156(31), 1246-1252. (Beérkezett: 2015 elfogadva: 2015. május 18.) Rövidítések cAMP = ciklikus adenozin-monofoszfát; COPD = krónikus obstruktív tüdőbetegség; FEV1 = forszírozott másodpercvolu-men; ISZB = ischaemiás s...

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“…Stewart et al 37 Abba et al 20 Okebe et al 31 comparison C Duley et al 48 Kabra et al 27 Humphreys et al 33 comparison A Komossa et al 42 Dodd et al 53 Halliday et al 35 Crowther et al 54 Duley et al 47 Abalos et al 51 comparison A Rumbold et al 56 Cates et al 12 Okebe et al 31 comparison B Buppasiri et al 59 Ducharme et al 11 Martí-Carvajal et al 62 Graves et al 30 Nannini et al 13 Lucero et al 28 Walters et al 21 Peña-Rosas et al 58 Spencer et al 15 Abalos et al 51 comparison B Thomas et al 29 Nannini et al 14 Karner et al 19 Welsh et al 18 King et al 49 Al revic et al 52 Okebe et al 31 comparison D Grimwade et al 24 Rumbold et al 55 Walters et al 9 Halliday et al 36 Soares-Weiser et al 23 Makrides et al 50 Hofmeyr et al 46 Cates et al 16 Cates et al 17 Poole et al 8 Grimwade et al 25 Barr et al 10 Imdad et al 45 Okebe et al …”

Section: Studymentioning

confidence: 99%

Concordance of effects of medical interventions on hospital admission and readmission rates with effects on mortality

Hemkens

Contopoulos‐Ioannidis

Ioannidis

2013

CMAJ

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Research CMAJ Background:Many clinical trials examine a composite outcome of admission to hospital and death, or infer a relationship between hospital admission and survival benefit. This assumes concordance of the outcomes "hospital admission" and "death." However, whether the effects of a treatment on hospital admissions and readmissions correlate to its effect on serious outcomes such as death is unknown. We aimed to assess the correlation and concordance of effects of medical interventions on admission rates and mortality. Methods:We searched the Cochrane Database of Systematic Reviews from its inception to January 2012 (issue 1, 2012) for systematic reviews of treatment comparisons that included meta-analyses for both admission and mortality outcomes. For each meta-analysis, we synthesized treatment effects on admissions and death, from respective randomized trials reporting those outcomes, using random-effects models. We then measured the concordance of directions of effect sizes and the correlation of summary estimates for the 2 outcomes. Results:We identified 61 meta-analyses including 398 trials reporting mortality and 182 trials reporting admission rates; 125 trials reported both outcomes. In 27.9% of comparisons, the point estimates of treatment effects for the 2 outcomes were in opposite directions; in 8.2% of trials, the 95% confidence intervals did not overlap. We found no significant correlation between effect sizes for admission and death (Pearson r = 0.07, p = 0.6). Our results were similar when we limited our analysis to trials reporting both outcomes. Interpretation:In this metaepidemiological study, admission and mortality outcomes did not correlate, and discordances occurred in about one-third of the treatment comparisons included in our analyses. Both outcomes convey useful information and should be reported separately, but extrapolating the benefits of admission to survival is unreliable and should be avoided. Abstract

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Tiotropium for stable chronic obstructive pulmonary disease

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 131 publications

References 51 publications

Drugs for COPD: current evidence

Drugs for COPD: current evidence

Van-e cardiovascularis mellékhatásuk az inhalációs antikolinerg szereknek?

Concordance of effects of medical interventions on hospital admission and readmission rates with effects on mortality

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