Combining tiotropium and salmeterol in COPD: Effects on airflow obstruction and symptoms

Abstract

Compared to single-agent therapy, combination therapy of tiotropium plus salmeterol in COPD provided clinically meaningful improvements in airflow obstruction and dyspnea as well as a reduction in reliever medication.

A Network Meta-Analysis of Long-Acting Muscarinic Antagonist (LAMA) and Long-Acting β2-Agonist (LABA) Combinations in COPD

“…Some RCTs have reported improved lung function outcomes using LAMA ? LABA therapies compared with LABA monotherapy; [15][16][17] these findings are consistent with the conclusions of two recent NMAs, which performed slightly different analyses to that presented in this study [47,48].…”

“…LABA combination therapy compared with TIO monotherapy are consistent with results from several RCTs which directly compared various LAMA ? LABA therapies with TIO [14][15][16][17][18][19][20]. This observation is therefore not unexpected and could be attributed to the direct agonist effect of the added LABA, as well as possible synergistic effects [13].…”

“…Included trials were required to report outcomes within a 4-week window at 12 (8)(9)(10)(11)(12)(13)(14)(15)(16) weeks and/or 24 (20)(21)(22)(23)(24)(25)(26)(27)(28) weeks. Outcomes of interest were: trough forced expiratory volume in 1 s (FEV 1 ), and the subjective PROs of breathlessness assessed by the Transition Dyspnea Index (TDI) focal score, health-related quality of life (HRQoL) assessed by the St George's Respiratory Questionnaire (SGRQ) total score, and rescue short-acting b 2 -agonist medication use (puffs/day).…”

“…In the last decade, multiple randomized controlled trials (RCTs) have reported that improvements in lung function and patient-reported outcomes (PROs) can be achieved with LAMA ? LABA combinations compared with the component monotherapies for patients with stable COPD, with no differences in safety [14][15][16][17][18][19][20].…”

Beyond lung function in COPD management: effectiveness of LABA/LAMA combination therapy on patient-centred outcomes

“…6,[15][16][17]19,20 Two further studies of tiotropium plus salmeterol (once or twice a day) also showed a marked improvement in dyspnoea with combination therapy over either monotherapy. 21,22 In a study by Aaron et al, 7 no significant difference in mean TDI total score was demonstrated between tiotropium plus salmeterol, tiotropium plus salmeterol/ fluticasone and tiotropium alone; however, it should be noted that a large number of patients discontinued during this study (61.0% completed), making it difficult to draw firm conclusions on efficacy between treatment groups. A greater proportion of patients achieved the minimum clinically important difference (MCID) in TDI total score of >1 unit with combination therapies than with LABA or LAMA monotherapy.…”