Tiotropium better than salmeterol for prevention of exacerbations of COPD

January 01, 0001

Tiotropium better than salmeterol for prevention of exacerbations of COPD

These German, Dutch, and Italian authors conducted a randomizced controlled trial to assess whether the anticholinergic drug tiotropium is superior to the beta2-agonist salmeterol in preventing exacerbations of COPD. They compared the effect of treatment with 18 mcg of tiotropium once daily with that of 50 mcg of salmeterol twice daily on the incidence of moderate or severe exacerbations in patients with moderate-to- very-severe COPD and a history of exacerbations in the preceding year.

They found: "A total of 7376 patients were randomly assigned to and treated with tiotropium (3707 patients) or salmeterol (3669 patients). Tiotropium, as compared with salmeterol, increased the time to the first exacerbation (187 days vs. 145 days), with a 17% reduction in risk (hazard ratio). Tiotropium also increased the time to the first severe exacerbation (hazard ratio, 0.72), reduced the annual number of moderate or severe exacerbations (0.64 vs. 0.72; rate ratio, 0.89), and reduced the annual number of severe exacerbations (0.09 vs. 0.13; rate ratio, 0.73). Overall, the incidence of serious adverse events and of adverse events leading to the discontinuation of treatment was similar in the two study groups. There were 64 deaths (1.7%) in the tiotropium group and 78 (2.1%) in the salmeterol group."

The authors concluded: "These results show that, in patients with moderate-to-very-severe COPD, tiotropium is more effective than salmeterol in preventing exacerbations."

Tiotropium is the preferred agent for treatment of severe COPD.

For the full abstract, click here.

N Engl J Med 364:1093-1103, 24 March 2011
© 2011 to the Massachusetts Medical Society
Tiotropium versus Salmeterol for the Prevention of Exacerbations of COPD. Claus Vogelmeier, Bettina Hederer, Thomas Glaab, et al. Correspondence to Dr. Fabbri: leonardo.fabbri@unimore.it

Category: R. Respiratory. Keywords: chronic obstructive pulmonary disease, COPD, salmeterol, tiotropium, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 19 April 2011

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