A Cochrane systematic review has found new moderate-quality evidence that tiotropium + long-acting beta2-agonist/inhaled corticosteroid (LABA/ICS) combination therapy reduces hospital admission for COPD patients, compared with tiotropium + placebo.  

Tiotropium, a long-acting bronchodilator, and single-inhaler LABA/ICS combination therapy are often used as maintenance treatment in patients with chronic obstructive pulmonary disease (COPD). Maria Ximena Rojas-Reyes, from Pontificia Universidad Javeriana, Bogota, DC, Colombia, and colleagues explored whether combining these treatments could be more effective than its separate components. They assessed relative effects of tiotropium + LABA/ICS vs. tiotropium, and tiotropium + LABA/ICS vs. LABA/ICS regarding exacerbations, symptoms, quality of life, and lung function in patients with COPD. 

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Study authors searched the Cochrane Airways Group Specialised Register of Trials and the World Health Organization (WHO) trials to include parallel, randomized-controlled with a duration of ≥3 months that compared ICS and LABA combination therapy in addition to tiotropium vs. tiotropium alone or combination therapy alone. A total of 6 studies (n=1,902) were included for the analysis, all of which compared tiotropium + ICS/LABA therapy vs. tiotropium alone. 

Rojas-Reyes and her team found no statistically significant differences in mortality between treatments (odds ratio [OR] 1.80, 95% CI: 0.55–0.91) and a reduction in all-cause hospitalizations with tiotropium + LABA/ICS (OR 0.61, 95% CI: 0.40–0.92). According to the St. George’s Respiratory Questionnaire (SGRQ), a statistically significant improvement in total score with the use of tiotropium + LABA/ICS vs. tiotropium alone was seen (mean difference [MD] –3.46, 95% CI: –5.05 to –1.87) regarding quality of life. Also, lung function significantly differed in the tiotropium + LABA/ICS group “although the average benefit with this therapy was small.” Investigators observed no statistically significant difference in adverse events, serious adverse events, and pneumonia.

One of the 6 studies also compared also evaluated tiotropium + LABA/ICS vs. LABA/ICS alone. Due to lack of power, the results did not allow for a conclusion to be drawn.

Overall, moderate-quality evidence indicated that tiotropium + LABA/ICS vs. tiotropium + placebo decreased hospital admission. Low-quality evidence suggested an improvement in disease-specific quality of life with tiotropium + LABA/ICS therapy. Evidence is lacking, however, to support the combination therapy for mortality (moderate-quality evidence) and exacerbations (low-quality evidence). Tiotropium + LABA/ICS did not increase adverse events or serious non-fatal adverse events when compared with tiotropium + placebo, study authors added.

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