Comparison of tiotropium plus formoterol to tiotropium alone in stable chronic obstructive pulmonary disease: a meta-analysis.

Summary of "Comparison of tiotropium plus formoterol to tiotropium alone in stable chronic obstructive pulmonary disease: a meta-analysis."

SUMMARY AT A
GLANCE:
A meta-analysis of eligible randomized controlled trials showed that in patients with stable COPD, tiotropium plus formoterol improved lung function and symptom scores compared with tiotropium alone, and there was a trend towards a decrease in adverse events in patients treated with the combination therapy.
ABSTRACT:
Background and objective:  It is not clear whether combination therapy with tiotropium plus formoterol has greater efficacy, without increasing the burden of adverse events, compared with tiotropium alone. This meta-analysis was performed to evaluate the differences in efficacy and adverse events associated with combination therapy compared with tiotropium alone, in patients with stable COPD. Methods:  MEDLINE, EMBASE, CINAHL and the Cochrane trials database were searched for this analysis. Randomized controlled trials of two or more weeks of treatment with tiotropium plus formoterol or arformoterol, compared with tiotropium alone, were reviewed. Studies were pooled to yield OR or weighted mean differences (WMD), with 95% CI. Results:  Eight trials, involving 1,868 randomized patients, met the inclusion criteria. Treatment with tiotropium plus formoterol significantly improved the average FEV(1) (WMD 105 mL, 95% CI 69 to 142), average FVC (WMD 135 mL, 95% CI 96 to 174) and trough FEV(1) (WMD 53 mL, 95% CI 30 to 76), compared with tiotropium alone, although the difference was not statistically significant for trough FVC. The mean change in transitional dyspnoea index (TDI) was markedly greater with tiotropium plus formoterol (WMD 1.50, 95% CI 1.01 to 1.99) than with tiotropium alone, and there was a similar difference in the proportion of patients with a clinically significant change in TDI (OR 2.34, 95% CI 1.58 to 3.46). There tended to be fewer adverse events and COPD exacerbations with tiotropium plus formoterol, compared with tiotropium alone, but the differences were not statistically significant. Conclusions:  Tiotropium plus formoterol significantly improved lung function and symptom scores compared with tiotropium alone. There was a trend towards a reduction in adverse events, although the difference was not statistically significant. Long term trials are necessary to evaluate the effects of tiotropium plus formoterol and to clarify the role of combination therapy, compared with tiotropium alone.

Affiliation

Department of Respiratory Diseases, Tongji Hospital, Key Lab of Pulmonary Diseases of Health Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan and Teaching and Research Division of Internal Medicine, Hubei College of C

Journal Details

This article was published in the following journal.

Name: Respirology (Carlton, Vic.)
ISSN: 1440-1843
Pages:

Links

• PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21138499
• DOI: http://dx.doi.org/10.1111/j.1440-1843.2010.01912.x