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Evaluation of withdrawal of maintenance tiotropium in COPD - 07/08/11

Doi : 10.1016/j.rmed.2009.05.018 
Sandra G. Adams a, , Antonio Anzueto a, Dick D. Briggs b, Inge Leimer c, Steven Kesten c
a The University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, Audie L. Murphy Division, 7400 Merton Minter Blvd. (111E), San Antonio, TX 78229, USA 
b University of Alabama at Birmingham, 355 Boshell Building, 1808 7th Avenue South, Birmingham, AL 35294-0012, USA 
c Boehringer Ingelheim Pharma, Binger Str. 173, 55216 Ingelheim am Rhein/Germany 

Corresponding author. Tel.: +1 210 617 5256; fax: +1 210 949 3006.

Summary

Introduction

In chronic diseases such as chronic obstructive pulmonary disease (COPD), patients may not perceive all of the benefits of drug therapy until withdrawal. Thus, we evaluated the effect of tiotropium withdrawal on clinical variables.

Methods

COPD subjects who participated in two identical 1-year, prospective, double-blind, placebo-controlled studies of tiotropium 18μg once daily who completed a 3-week visit following discontinuation of therapy were included in this analysis. Outcomes measured included dyspnea (transition dyspnea index [TDI]), Peak Expiratory Flow Rate (PEFR), health status (St George's Respiratory Questionnaire [SGRQ]), and rescue β2-agonist use.

Results

Overall, the tiotropium group exhibited significant improvements in clinical parameters at the end of therapy. Of the entire cohort of 921 patients, 713 patients (77%) completed 3-weeks post-withdrawal evaluation. Patients in the tiotropium group had 1.1 unit worsening in TDI, decreased in PEFR, health status and reduced β2-agonist medication following treatment discontinuation, while the placebo group remained relatively stable.

Conclusions

The withdrawal of tiotropium results in worsening of COPD over a three-week interval. There was no evidence of a rebound effect in response to tiotropium withdrawal.

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Keywords : COPD, Tiotropium, Spirometry, Peak expiratory flow rate, St. George's Respiratory Questionnaire, Transition dyspnea index


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© 2009  Publié par Elsevier Masson SAS.
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Vol 103 - N° 10

P. 1415-1420 - octobre 2009 Retour au numéro
Article précédent Article précédent
  • Endobronchial ultrasound
  • Devanand Anantham, Mariko Siyue Koh, Armin Ernst
| Article suivant Article suivant
  • Tiotropium and risk for fatal and nonfatal cardiovascular events in patients with chronic obstructive pulmonary disease: Systematic review with meta-analysis
  • Gustavo J. Rodrigo, José A. Castro-Rodriguez, Luís J. Nannini, Vicente Plaza Moral, Eduardo A. Schiavi

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