Tiotropium as a first maintenance drug in COPD: secondary analysis of the UPLIFT trial.

Abstract

The aim of the present study was investigate the long-term effect of tiotropium as first maintenance respiratory medication in chronic obstructive pulmonary disease (COPD). A 4-yr, randomised, multicentre, double-blind, parallel-group, placebo-controlled trial (Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) was conducted. Analysis focused on the effect of tiotropium versus matching placebo in the 810 (13.5%) COPD patients not on other maintenance treatment (long-acting beta-agonists, inhaled corticosteroids, theophyllines or anticholinergics) at randomisation. Spirometry, health-related quality of life (St George's Respiratory Questionnaire (SGRQ) score), exacerbations of COPD and mortality were also analysed. 403 patients (mean+/-sd age 63+/-8 yrs, post-bronchodilator forced expiratory volume in 1 s (FEV(1)) 53+/-12% predicted) received tiotropium and 407 (64+/-8 yrs of age, post-bronchodilator FEV(1) 51+/-12% pred) received placebo. Post-bronchodilator FEV(1) decline was 42+/-4 mL.yr(-1) in the tiotropium group and 53+/-4 mL.yr(-1) in the placebo group (p = 0.026). At 48 months, the morning pre-dose FEV(1) was 134 mL higher in the tiotropium group compared to the placebo group (p<0.001). SGRQ total score declined more slowly in the tiotropium group (difference of 1.05+/-0.34 units.yr(-1); p = 0.002). This was particularly significant for the impact (difference of 1.08+/-0.37 units.yr(-1); p = 0.004) and activity (1.44+/-0.40 units.yr(-1); p<0.001) domains, but not for symptoms (0.26+/-0.50 units.yr(-1); p = 0.6). At 48 months, the difference in total score was 4.6 units (p<0.001) with tiotropium compared to placebo. In patients with COPD who are not on maintenance therapy, tiotropium is associated with significant benefits in disease progression.

• Authors: T Troosters, B Celli, T Lystig, S Kesten, S Mehra, D P Tashkin, M Decramer, Uplift Investigators
• Journal: The European respiratory journal (Eur Respir J) Vol. 36 Issue 1 Pg. 65-73 (Jul 2010) ISSN: 1399-3003 [Electronic] England
• PMID: 20185426 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones
• Adrenergic beta-Agonists
• Bronchodilator Agents
• Cholinergic Antagonists
• Scopolamine Derivatives
• Theophylline
• Tiotropium Bromide

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Adrenergic beta-Agonists (therapeutic use)
• Aged
• Bronchodilator Agents (therapeutic use)
• Cholinergic Antagonists (therapeutic use)
• Disease Progression
• Female
• Forced Expiratory Volume (drug effects)
• Humans
• Male
• Middle Aged
• Pulmonary Disease, Chronic Obstructive (drug therapy, mortality)
• Quality of Life
• Scopolamine Derivatives (therapeutic use)
• Spirometry
• Theophylline (therapeutic use)
• Time
• Tiotropium Bromide