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 showed.
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) in 2004-2006, 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 on monotherapy with tiotropium (Spiriva) had significantly lower rates of disease-related hospital admissions during 12 months of follow-up than those on salmeterol (Serevent), formoterol fumarate (Foradil), salmeterol/fluticasone propionate (Advair), or combination therapy with two or more LABDs, said Dr. Durden of Thomson Reuters. (See box.)
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 prestudy 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 can't provide proof that tiotropium was the actual cause of the significantly lower hospitalization rate.
However, Dr. Donald P. Tashkin described a new meta-analysis he and his coworkers have conducted that incorporated data from 30 placebo-controlled clinical trials of tiotropium for COPD, 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 based upon more than 13,000 patient-years of exposure to the LABD.
Disclosures: Dr. Tashkin's meta-analysis and Dr. Durden's study were both funded by Boehringer Ingelheim and Pfizer, which comarket tiotropium. Dr. Tashkin is a consultant to both companies. Dr. Durden reported having no financial conflicts.
Source Elsevier Global Medical News