SAN DIEGO — Patients whose chronic obstructive pulmonary disease was treated with tiotropium monotherapy had significantly fewer disease-related hospitalizations during a 12-month window than those on other long-acting bronchodilator regimens, a large national study shows.
The retrospective study looked at COPD-related inpatient admissions in Thomson MarketScan, a large U.S. administrative claims database.
The analysis involved 52,274 commercially insured patients with COPD who had one or more prescription claims for a long-acting bronchodilator (LABD) from 2004 to 2006, Emily D. Durden, Ph.D., reported at the annual meeting of the American College of Chest Physicians.
The COPD patients were categorized into five LABD regimens.
Those who were on monotherapy with tiotropium (Spiriva) had significantly lower rates of disease-related hospital admissions during 12 months of follow-up than those using salmeterol (Serevent), formoterol fumarate (Foradil), salmeterol/fluticasone propionate (Advair), or combination therapy with two or more LABDs, said Dr. Durden of Thomson Reuters in Austin, Tex. (See chart.)
The association between LABD regimen and COPD-related hospital admissions was evaluated in a multivariate logistic regression analysis that adjusted for potential confounders including age, gender, urban versus rural location, comorbid conditions, insurance type, emergency department use, and respiratory hospitalizations during the 6 months immediately prior to the 12-month study period.
Patients in the tiotropium monotherapy group had significantly more comorbidities than those in the other study arms. They also were more likely to have been vaccinated against influenza. Mean health care costs in the 6-month pre-period were lowest in the salmeterol group at $12,885 and highest in patients on combination LABD therapy, at nearly $17,100.
Dr. Durden noted that the retrospective, nonrandomized nature of her study means that it cannot provide proof that tiotropium was the actual cause of the significantly lower hospitalization rate.
However, Dr. Donald P. Tashkin described a new meta-analysis that he and his coworkers recently conducted, which incorporated data from 30 placebo-controlled clinical studies of tiotropium in COPD patients, including the massive 4-year Understanding Potential Long-Term Impacts on Function With Tiotropium (UPLIFT) trial (Chest 2010;137:20-30).
The results of this meta-analysis indicate that tiotropium provided a 12% reduction in the risk of all-cause mortality relative to placebo and a 17% reduction in the risk of composite cardiovascular events, including stroke as well as MI, said Dr. Tashkin, professor emeritus of medicine at the University of California, Los Angeles.
The relative risks of acute MI and of heart failure were reduced by 23% and 17%, respectively, in this analysis, which was based upon more than 13,000 patient-years of exposure to the LABD.
Source Elsevier Global Medical News