The Effect of Tiotropium on COPD GOLD Stage II during the Four-Year UPLIFT Trial.

Pro-inflammatory mechanisms of muscarinic receptor stimulation in airway smooth muscle

“…Nonetheless, in a subgroup of COPD patients of the UPLIFT study, which were not on other controller medication, a reduction in the accelerated FEV 1 decline was observed in the tiotropium bromide arm (post-hoc analysis of the UPLIFT study [44]). This was also observed in the subgroup of stage II COPD patients [45]. Collectively, besides the well described bronchodilatory effects, these findings suggest additional, non-bronchodilator properties for tiotropium bromide [6].…”

Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomised, placebo-controlled TORCH study

“…Indeed guidelines require this type of post-hoc analysis since they encourage more targeted therapy to specific patient groups. Based on the size of studies like TORCH and UPLIFT [ 10 ], there is reasonable power to conduct exploratory post-hoc analysis of secondary outcomes. In the case of TORCH, where approximately one-third of the TORCH study population fell into the GOLD stage II category, the present post-hoc analysis demonstrates that SFC improved SGRQ, reduced exacerbations and improved lung function when compared with placebo.…”

“…This distribution appears to be similar to the FEV 1 % predicted distribution of stage II COPD patients from a 2005–2007 UK General Practice Research Database population-based cohort study [GSK Worldwide Epidemiology (WEUSKOP2207) Final study report, May 2009. Data on file] and the demographics of the TORCH GOLD stage II population is also similar to that of the UPLIFT clinical trial [ 10 ]. The majority of patients were also sufficiently symptomatic, as indicated by high baseline SGRQ total score, to have presented and been diagnosed with COPD, most likely as a result of exacerbations.…”

“…These data contributed to COPD treatment guidelines recommending the use of ICS/LABA combinations to reduce the frequency and severity of exacerbations and improving lung function and health status in patients with more severe COPD (forced expiratory volume in one second [FEV 1 ] < 50% predicted) and a history of exacerbations. The absence of RCT data applicable to patients with GOLD stage II COPD can now be redressed through analysis of the results in patients with milder disease in recent large trials [ 2 , 10 ].…”

Effect of tiotropium on quality of life in COPD: a systematic review

“…Of the 40 excluded publications, seven did not cite an eligible smoking history, 10-16 five reported duplicate data published elsewhere, [17][18][19][20][21] 11 reported no relevant data, 22-32 and 17 were not double-blind RCTs. [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] Of the 24 publications that met the inclusion criteria for this systematic review (see Table 1), 16 compared tiotropium with placebo, [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] seven compared tiotropium with an active comparator, [66][67][68][69][70][71][72] and one compared tiotropium with both placebo and an active comparator.…”