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Patients With COPD May Benefit From Earlier Tiotropium Treatment

NEW YORK -- August 27, 2009 -- While the effectiveness of drug therapy for COPD patients at advanced stages of disease has been proven, little evidence exists regarding starting treatment at earlier stages.

The findings from the Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) are published online first in this week's COPD special issue of The Lancet.

The study showed that treatment with inhaled tiotropium at an earlier stage of COPD reduces decline of lung function, and thus treatment should begin at this earlier stage.

Although the UPLIFT study investigated patients at all stages of the disease, the authors in this paper did a pre-specified subgroup analysis of patients specifically at Global Initiative for Chronic Obstructive Lung Disease stage 2. From a total of 5,993 patients, 2,739 had GOLD stage 2 COPD at randomisation, with a mean age of 64 years.

Pre-bronchodilator spirometry was done prior to administration of study drug in the morning of a clinic visit. Post-bronchodilator spirometry was performed after study drug and short-acting bronchodilators (ipratropium and salbutamol).

The patients had a mean post-bronchodilator forced expiratory volume in the first second of expiration (FEV1) of 1.63L, 59% of the predicted value.

A total of 2,376 patients qualified for the final analysis. Of these, 1,218 patients had received tiotropium and 1,158 placebo over a period of 4 years.

The researchers found that the rate of decline of mean post-bronchodilator FEV1 per year was 12% lower in the tiotropium group than the placebo group (43 mL vs 49 mL). The rate of decline of mean pre-bronchodilator FEV1 did not differ significantly between groups (35 mL vs 37 mL per year).

Patients given tiotropium were also found to have better health status (measured by questionnaire) at all timepoints, a lower risk of exacerbation (reduced by 18%), and a lower risk of being hospitalised due to an exacerbation (reduced by 26%).

"In patients with GOLD stage 2 COPD, long-term treatment with tiotropium seemed to reduce the rate of decline of post-bronchodilator FEV1 and the risk of exacerbations. Since we also found that lung function and health-related quality of life were better in the tiotropium group than in the control group throughout the trial, treatment of COPD should begin in symptomatic patients with moderate disease."

SOURCE: The Lancet

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