Outcomes/Effectiveness Research

COPD drug triad associated with reduced death and hospitalization rates

Coughing, wheezing, shortness of breath, and chest tightness are common symptoms of chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in the United States. Physicians often prescribe the drug tiotropium (Spiriva®) along with inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) to open up patients' narrowed breathing passages and reduce COPD symptoms. This drug trio decreases the chance of death, reduces breathing crises (exacerbations), and curbs hospitalizations, finds a new study from the Chicago-area Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Program.

After studying medical records from 42,090 patients seen in the Veterans Affairs health care system, researchers found that patients who used tiotropium along with ICS and LABA had a 40 percent reduced risk of death, a 16 percent smaller risk of exacerbations, and 22 percent fewer hospitalizations compared with patients who received only ICS and LABA. These results were not consistently seen with other drug combinations and tiotropium, however. For example, when the three drugs were used along with ipratropium, researchers noted a 36 percent increased risk of death compared with patients who received only ICS and LABA.

The authors assert that these real-life studies provide valuable information that complements the results gathered from clinical trials, which typically include more restricted study populations and do not reflect how the drugs will actually be used once they become available. Further, these comparative effectiveness studies help clinicians and patients make treatment decisions on tailored therapies.

This study was funded in part by the Agency for Healthcare Research and Quality (AHRQ, Contract No. 290-05-0038). For more information on the AHRQ-sponsored DEcIDE Network, visit effectivehealthcare.ahrq.gov/index.cfm/who-is-involved-in-the-effective-health-care-program1/about-the-decide-network.

See "Outcomes associated with tiotropium use in patients with chronic obstructive pulmonary disease," by Todd A. Lee, Pharm.D., Ph.D., Caitlyn Wilke, M.S., Min Joo, M.D., M.P.H., and others in the August 10, 2009 Archives of Internal Medicine 169(15), pp. 1403-1410.

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