Patients with COPD that are prescribed tiotropium are less likely to experience exacerbations, compared to LABAs.
Tiotropium was associated with a significant 13% reduction in the likelihood of experiencing exacerbations leading to hospitalisation, compared to LABAs, and a 14% reduction in the risk of experiencing any exacerbation. No differences were found when the different types of LABA were compared to tiotropium for this outcome.
Tiotropium also came out favourably when non-fatal serious adverse events were analysed – a 12% decrease in risk with tiotropium compared to LABA.
There was no difference found between the two for mortality rates, FEV1 or symptom score, but the LABA indacaterol did produce significantly improved scores for quality of life, as measured on the St George's Respiratory questionnaire.
A cost analysis found that the cost for exacerbations per patient was £169 less for tiotropium compared to salmeterol in England, and £136 less for the remaining British Isles.
The results come from a new Cochrane review published in September this year investigating the efficacy of the two drugs in COPD. Seven randomised controlled trials of at least 12 weeks duration were pooled together. Economic evaluations were also considered provided they were conducted alongside a trial, of which six were included in the final analysis.
Participants all had a diagnosis of stable COPD and received either inhaled tiotropium or a LABA, given in any formulation. Patients were allowed inhaled corticosteroids and other concomitant COPD medication providing it was not part of the randomised treatment.
Exacerbations were defined as those requiring short-burst oral corticosteroids or an antibiotic, while quality of life was measured using any validated scale for COPD. LABAs
The research left the authors urging GPs to allow patients to choose which bronchodilator they prefer.
They said: ‘One approach may be to give a COPD patients a substantial trial of tiotropium, followed by a LABA, then to continue prescribing the long-acting bronchodilator that the patient prefers.'
Cochrane 2012, published online 12 September
