The prevention of COPD exacerbations by salmeterol/fluticasone propionate or tiotropium bromide.
American journal of respiratory and critical care medicine
; 177(1): 19-26, Jan. 2008. tabgraf
Article
in English
| MedCarib
| ID: med-17800
Responsible library:
TT5
Localization: TT5; W1, AM521NF
ABSTRACT
Rationale Exacerbations are key drivers of morbidity and mortality in chronicobstructive pulmonary disease (COPD).Objectives:
We compared the relative efficacy of the long-acting inhaledbronchodilator/anti-inflammatory combination (salmeterol/fluticasone propionate) 50/500mcg bd and the long-acting bronchodilator (tiotropium) 18mcg od in preventing exacerbations and related outcomes in moderate severe COPDMethods:
1323 patients (mean age 64yr, forced expiratory volume in 1sec 39 per cent predicted) were randomized in 2-year, double blind, double-dummy, parallel study.Measurements and MainResults:
Primary endpoint was healthcare utilization exacerbation rate. Other endpoints included health status measured by St. Georges Respiratory Questionnaire (SGRQ), mortality, adverse events and study withdrawal.Probability of withdrawing from the study was 29 per cent greater with tiotropium than salmeterol/fluticasone propionate (p=0.005). The modelled annual exacerbation rate was 1.28 in the salmeterol/fluticasone propionate group and 1.32 in the tiotropium group (rate ratio 0.967 [95 per cent CI 0.836 to 1.119]; p=0.656). The SGRQ total score was statistically significantly lower at 2 years on salmeterol/fluticasone propionateversus tiotropium (difference 2.1 units, 95 per cent CI 0.1 to 4.0, p=0.038). Mortality was significantly lower in the salmeterol/fluticasone propionate group; 21 (3 per cent of patients in this group died compared to 38 (6 per cent) in the tiotropium group (p=0.032). Morepneumonias were reported in the salmeterol/fluticasone propionate group relative to tiotropium (p=0.008).Conclusions:
We found no difference in exacerbation rate between salmeterol/fluticasone propionate and tiotropium. More patients failed to complete the study receiving tiotropium. A small statistically significant beneficial effect was found on health status, with an unexpected finding of lower deaths in salmeterol/fluticasone propionate treated patients.
Full text:
Available
Collection:
International databases
Health context:
SDG3 - Health and Well-Being
/
SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases
Health problem:
Target 3.4: Reduce premature mortality due to noncommunicable diseases
/
Chronic Obstructive Pulmonary Disease (COPD)
/
Other Respiratory Diseases
Database:
MedCarib
Main subject:
Health Status
/
Mortality
/
Pulmonary Disease, Chronic Obstructive
Type of study:
Controlled clinical trial
/
Prognostic study
Aspects:
Social determinants of health
/
Patient-preference
Limits:
Humans
Language:
English
Journal:
American journal of respiratory and critical care medicine
Year:
2008
Document type:
Article
Institution/Affiliation country:
Academic Unit of Respiratory Medicine/United Kingdom
/
Department of Clinical Medical Sciences/Trinidad and Tobago
/
Department of Medicine/United Kingdom
/
Respiratory Medicines Centre/United Kingdom