TY - JOUR T1 - The utility of tiotropium among patients with chronic obstructive pulmonary disease (COPD): An updated meta-analysis of randomized controlled trials JF - European Respiratory Journal JO - Eur Respir J VL - 42 IS - Suppl 57 SP - P262 AU - Johann Paolo Augusto Almazar AU - Hazel Delfin AU - Joel Santiaguel Y1 - 2013/09/01 UR - http://erj.ersjournals.com/content/42/Suppl_57/P262.abstract N2 - Tiotropium, an inhaled anticholinergic used in the management of COPD, exhibits an effective bronchodilator response at once-daily dosing. In 2010, the US-FDA issued a statement indicating its cardiovascular safety based on the UPLIFT trial, the largest and longest placebo-controlled trial on Tiotropium. However, there is still question on the drug’s cardiovascular safety, especially in comparison to inhaled LABAs. We determined the efficacy of long-term tiotropium use on mortality, exacerbations, and hospitalizations compared to inhaled LABAs. RCTs among patients with COPD comparing Tiotropium monotherapy with inhaled LABAs with at least 6 months follow-up were identified from different electronic databases and thru handsearching. Data on all-cause mortality, mortality from pulmonary and cardiovascular causes, and rates of hospitalizations and exacerbations were identified. The date of last search is September 7, 2012. Two independent investigators evaluated and extracted relevant data. From 495 studies, 5 trials with a total of 10,759 patients met inclusion criteria. Tiotropium did not reduce all-cause mortality (RR 0.83 95%CI 0.40-1.70), mortality from respiratory causes (RR 0.70 95%CI 0.40-1.25), and mortality from cardiovascular causes (RR 1.57 95%CI 0.86-2.85). Tiotropium significantly decreased the risk for exacerbations (RR 0.91 95%CI 0.85-0.98), and exhibited a trend towards decreased hospitalizations (RR 0.78 95%CI 0.61-1.00).Tiotropium did not reduce mortality compared to inhaled LABAs. Tiotropium significantly decreased the risk for exacerbations, and showed a trend towards possible decreased hospitalizations. ER -