Comparison of tiotropium bromide and combined ipratropium/salbutamol for the treatment of COPD: a UK General Practice Research Database 12-month follow-up study

Griffin, Jane; Lee, Sally; Caiado, Maria; Kesten, Steven; Price, David

doi:10.3132/pcrj.2008.00024

Cited by 25 publications

(19 citation statements)

References 26 publications

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“…Findings from randomised controlled trials are complemented by results from a recent casecontrol study supporting efficacy of tiotropium in a real-life setting. 23 Our analysis, which accommodates all available long-term data with tiotropium 18mcg once daily to date and which provides level 1A evidence on tiotropium efficacy, 24- . 27 This trial showed that tiotropium was associated with a 14% reduction in COPD exacerbations and associated hospitalisations.…”

Section: Discussionmentioning

confidence: 99%

Patient-level pooled analysis of the effect of tiotropium on COPD exacerbations and related hospitalisations

Halpin

Menjoge

Viel

2009

Primary Care Respiratory Journal

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Aim: To assess the effect of tiotropium 18mcg once daily on chronic obstructive pulmonary disease (COPD) exacerbations and exacerbation-related hospitalisations using a patient-level pooled analysis.Methods: All completed randomised, placebo-controlled, parallel-group tiotropium trials with a duration of >24 weeks were included (n=9). An exacerbation was defined in each study as >2 respiratory symptoms lasting >3 days, and requiring treatment with antibiotics and/or systemic steroids and/or hospitalisation.Results: Compared with placebo (2,862 patients), tiotropium (3,309 patients) significantly reduced by 21% both the risk of COPD exacerbation (95% confidence interval [CI] 0.73-0.86; p<0.0001) and the risk of exacerbation-associated hospitalisation (95% CI 0.65-0.96; p=0.015). Time to first exacerbation and first associated hospitalisation were increased. The protective effect of tiotropium was consistent regardless of age, gender, inhaled corticosteroid use and disease severity. Conclusion:This analysis provides further confirmatory evidence that tiotropium reduces the risk of exacerbation and associated hospitalisation.

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Section: Discussionmentioning

confidence: 99%

Patient-level pooled analysis of the effect of tiotropium on COPD exacerbations and related hospitalisations

Halpin

Menjoge

Viel

2009

Primary Care Respiratory Journal

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“…These generally use information from administrative or prescribing databases and have the strength that they include all types of patients (age, sex, smoking status, FEV 1, co-morbidities). 21 Yet interpretation of these studies can be difficult; the outcomes observed may be confounded by the fact that clinicians obviously had a reason to prescribe the therapy and thus there are likely to be systematic differences between patients who received the intervention and those who did not. 22 Although attempts are often made to try to control for these confounders, some of the information upon which the decision was made may not be available in the database and many proponents of evidence-based medicine dismiss observational studies: "If you find that [a] study was not randomised, we'd suggest that you stop reading it and go on to the next article."…”

Section: Are the Results Applicable In Patients Of All Types?mentioning

confidence: 99%

Lessons from the major studies in COPD: problems and pitfalls in translating research evidence into practice

Halpin

2010

Primary Care Respiratory Journal

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SummaryTranslating the growing evidence base on COPD management into practice can be challenging and understanding the strengths and weakness of published studies is crucial. Studies should conform to the standards of CONSORT statement; they should be sufficiently powered, participants should be randomised, there should be assignment concealment, and the outcome measures and analyses should be decided in advance.The interpretation of the results may be affected by age and severity inclusion criteria for the study and the exclusion of patients with co-morbid illnesses. Whether previous medication is continued or stopped can affect the interpretation of the results. Secondary analyses in sub-groups should be viewed with caution unless pre-specified and accommodated in the trial design and power calculations. Real world observational studies may be confounded by non-randomisation of participants but can sometimes yield valuable insights.The way in which the results are presented can influence their interpretation and their magnitude with respect to minimal important differences as well as statistical significance is important.Research studies help formulate management algorithms but often the questions they address are too specific to allow evidence-based sequencing of therapies.

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“…Actually, there is documentation from a retrospective study, which used real-life data, that tiotropium is associated with significantly better disease outcomes in all measures investigated when compared to salbutamol/ ipratropium [46]. Unfortunately, there is no data yet available on the benefit of LABA/LAMA FDC over LAMA, and also LABA, in real life although the results of pivotal randomized clinical trials indicate that this is the case.…”

Section: Lama/laba In the Prevention Of Exacerbationsmentioning

confidence: 99%

Indacaterol/Glycopyrronium Combination for COPD

Cazzola

Ora²,

Puxeddu

et al. 2017

Pulm Ther

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Comparison of tiotropium bromide and combined ipratropium/salbutamol for the treatment of COPD: a UK General Practice Research Database 12-month follow-up study

Abstract: Tiotropium is associated with a reduced risk of exacerbations and COPD-related referrals and hospitalisation compared to combined ipratropium/salbutamol in patients with COPD.

Cited by 25 publications

References 26 publications

Patient-level pooled analysis of the effect of tiotropium on COPD exacerbations and related hospitalisations

Patient-level pooled analysis of the effect of tiotropium on COPD exacerbations and related hospitalisations

Lessons from the major studies in COPD: problems and pitfalls in translating research evidence into practice

Indacaterol/Glycopyrronium Combination for COPD

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