The prevention of COPD exacerbations by salmeterol/fluticasone propionate or tiotropium bromide.
American journal of respiratory and critical care medicine
; 177(1): 19-26, Jan. 2008. tabgraf
Artigo
em Inglês
| MedCarib
| ID: med-17800
Biblioteca responsável:
TT5
Localização: TT5; W1, AM521NF
ABSTRACT
Rationale Exacerbations are key drivers of morbidity and mortality in chronicobstructive pulmonary disease (COPD).Objectives:
We compared the relative efficacy of the long-acting inhaledbronchodilator/anti-inflammatory combination (salmeterol/fluticasone propionate) 50/500mcg bd and the long-acting bronchodilator (tiotropium) 18mcg od in preventing exacerbations and related outcomes in moderate severe COPDMethods:
1323 patients (mean age 64yr, forced expiratory volume in 1sec 39 per cent predicted) were randomized in 2-year, double blind, double-dummy, parallel study.Measurements and MainResults:
Primary endpoint was healthcare utilization exacerbation rate. Other endpoints included health status measured by St. Georges Respiratory Questionnaire (SGRQ), mortality, adverse events and study withdrawal.Probability of withdrawing from the study was 29 per cent greater with tiotropium than salmeterol/fluticasone propionate (p=0.005). The modelled annual exacerbation rate was 1.28 in the salmeterol/fluticasone propionate group and 1.32 in the tiotropium group (rate ratio 0.967 [95 per cent CI 0.836 to 1.119]; p=0.656). The SGRQ total score was statistically significantly lower at 2 years on salmeterol/fluticasone propionateversus tiotropium (difference 2.1 units, 95 per cent CI 0.1 to 4.0, p=0.038). Mortality was significantly lower in the salmeterol/fluticasone propionate group; 21 (3 per cent of patients in this group died compared to 38 (6 per cent) in the tiotropium group (p=0.032). Morepneumonias were reported in the salmeterol/fluticasone propionate group relative to tiotropium (p=0.008).Conclusions:
We found no difference in exacerbation rate between salmeterol/fluticasone propionate and tiotropium. More patients failed to complete the study receiving tiotropium. A small statistically significant beneficial effect was found on health status, with an unexpected finding of lower deaths in salmeterol/fluticasone propionate treated patients.
Texto completo:
Disponível
Coleções:
Bases de dados internacionais
Contexto em Saúde:
ODS3 - Saúde e Bem-Estar
/
ODS3 - Meta 3.4 Reduzir as mortes prematuras devido doenças não transmissíveis
Problema de saúde:
Meta 3.4: Reduzir as mortes prematuras devido doenças não transmissíveis
/
Doença Pulmonar Obstrutiva Crônica (DPOC)
/
Outras Doenças Respiratórias
Base de dados:
MedCarib
Assunto principal:
Nível de Saúde
/
Mortalidade
/
Doença Pulmonar Obstrutiva Crônica
Tipo de estudo:
Ensaio clínico controlado
/
Estudo prognóstico
Aspecto:
Determinantes sociais da saúde
/
Preferência do paciente
Limite:
Humanos
Idioma:
Inglês
Revista:
American journal of respiratory and critical care medicine
Ano de publicação:
2008
Tipo de documento:
Artigo
Instituição/País de afiliação:
Academic Unit of Respiratory Medicine/United Kingdom
/
Department of Clinical Medical Sciences/Trinidad and Tobago
/
Department of Medicine/United Kingdom
/
Respiratory Medicines Centre/United Kingdom