RT Journal
A1 Lee TA, Wilke C, Joo M, et al
T1 OUtcomes associated with tiotropium use in patients with chronic obstructive pulmonary disease
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2009
FD August 10
VO 169
IS 15
SP 1403
OP 1410
DO 10.1001/archinternmed.2009.233
UL http://dx.doi.org/10.1001/archinternmed.2009.233
AB Background 
    To date, there is mixed evidence on the safety and effectiveness of tiotropium. Our objective was to evaluate the comparative effectiveness of regimens containing tiotropium bromide vs other medication regimens for chronic obstructive pulmonary disease (COPD) in real-world clinical settings.Methods 
    We conducted a cohort study on 2 separate cohorts with a diagnosis of COPD in the Veterans Affairs health care system. Patients with a diagnosis of COPD prescribed tiotropium and patients in a historic cohort prior to the introduction of tiotropium were selected for comparison using propensity scores, with the base case including scores from 0.1 to 0.4. Outcomes identified during follow-up were all-cause mortality, COPD exacerbations, and COPD hospitalizations. Exposure to COPD medication regimens was defined in a time-varying manner and Cox proportional hazards regression were used to evaluate outcomes.Results 
    For 42 090 patients in the base case, the regimen of tiotropium + inhaled corticosteroids (ICS) + long-acting β-agonists (LABA) was associated with 40% reduced risk of death (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.45-0.79) compared with ICS + LABA. This combination was associated with reduced rates of COPD exacerbations (HR, 0.84; 95% CI, 0.73-0.97) and COPD hospitalizations (HR, 0.78; 95% CI, 0.62-0.98). Tiotropium in combination with 2 other medications was associated with increased risk of mortality, exacerbations, and hospitalizations.Conclusions 
    When used with ICS and LABA, tiotropium use was associated with a decreased risk of mortality compared with treatment with ICS and LABA. However, this result was not consistent in other medication regimens that included tiotropium.