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COPD treatment with tiotropium does not increase cardiovascular risk

Within the first year of treatment, chronic obstructive pulmonary disease patients initiating tiotropium did not have an increased risk for cardiovascular events, but they did have a reduced risk for pneumonia, compared with long-acting beta2-agonists, according to a recent study. 

“Long-acting bronchodilators, including long-acting beta2-agonists (LABAs) and the long-acting anticholinergic tiotropium, are recommended as first-line maintenance therapy in the management of chronic obstructive pulmonary disease (COPD),” Samy Suissa, PhD, of the Lady Davis Institute at Jewish General Hospital, and colleagues wrote. “However, these agents can potentially cause cardiac complications, including tachyarrhythmia and coronary insufficiency, and their comparative safety remains uncertain.”

Suissa and colleagues identified eligible subjects from the United Kingdom’s Clinical Practice Research Datalink to evaluate the safety of long-acting bronchodilator use for COPD treatment. The study cohort consisted of patients aged 55 years or older who initiated either tiotropium or LABA during 2002 to 2012.

Based on high-dimensional propensity scores and prior inhaled corticosteroid use, the researchers matched 26,442 tiotropium initiators to 26,442 LABA initiators, who primarily used single inhalers along with inhaled corticosteroids.

Incidences of cardiovascular events — such as acute myocardial infarction (AMI), stroke, heart failure and pneumonia — were documented over the course of one year.

Researchers measured the HR for AMI associated with tiotropium initiation compared with LABA initiation was 1.10 (95% CI: 0.88-1.38); the HR for stroke was 1.02 (95% CI: 0.78-1.34), for arrhythmia was 0.81 (95% CI: 0.60-1.09), and for heart failure was 0.90 (95% CI: 0.79-1.02).

Patients treated with tiotropium had a significantly lower occurrence of pneumonia (HR 0.81; 95% CI: 0.72-0.92).

“In this real world setting study of the treatment of COPD, the initiation of maintenance treatment with tiotropium compared with a LABA does not increase cardiovascular risk, but reduces significantly the risk of pneumonia, albeit a likely adverse effect of the inhaled corticosteroid component present in many LABA inhalers,” Suissa and colleagues concluded. “This differential risk that appears to confer a safety advantage to tiotropium as the initial long-acting bronchodilator in COPD should be considered against the comparative effectiveness of these two treatments at initiation.” – by Alaina Tedesco

Disclosure: Suissa reports research grants from Boehringer-Ingelheim and has participated in advisory board meetings or as a speaker for AstraZeneca, Boehringer-Ingelheim, Novartis, and Pfizer. The other researchers did not report any relevant financial disclosures.