Summary of findings for the main comparison. Tiotropium versus long‐acting beta‐agonists for stable chronic obstructive pulmonary disease.
| Tiotropium versus long‐acting beta‐agonists for stable chronic obstructive pulmonary disease | ||||||
|
Patient or population: patients with stable chronic obstructive pulmonary disease and > 10 pack years smoking history
Settings: community
Intervention: tiotropium Comparison: LABA | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| LABA | Tiotropium | |||||
|
Quality of life (SGRQ) Follow‐up: 3 to 12 months |
See comment | See comment | Not estimable | 4935 (4 studies) | See comment | The results were not pooled because of substantial heterogeneity between the studies |
|
Patients with 1 or more exacerbations Follow‐up: 3 to 12 months |
29 per 100 | 26 per 100 (25 to 28) | OR 0.86 (0.79 to 0.93) | 12,123 (6 studies) | ⊕⊕⊕⊝ moderate1 | |
| Mortality (all‐cause) Follow‐up: 3 to 12 months | 14 per 1000 | 11 per 1000 (8 to 15) | OR 0.82 (0.60 to 1.13) | 12,123 (6 studies) | ⊕⊝⊝⊝ very low1,2,3 | |
|
Cost‐effectiveness Follow‐up: 1 to 5 years |
See comment | See comment | See comment | (6 economic evaluations) | ⊕⊕⊝⊝ low4,5 | In all 6 studies tiotropium was estimated to be superior to salmeterol based on better clinical outcomes (exacerbations or quality of life), lower total costs6 or both |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; LABA: long‐acting beta2‐agonist; OR: odds ratio; SGRQ: St George's Respiratory Questionnaire | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 (‐1) In two out of six studies tiotropium treatment was not blinded. 2 (‐1) There was moderate heterogeneity between the studies (I2 = 51%). 3 (‐1) There were very few events leading to wide confidence intervals.
4 (‐1) There was substantial uncertainty around the results in all of the studies.
5 (‐1) Two studies drew conclusions about the cost‐effectiveness of tiotropium compared to salmeterol through indirect comparisons with placebo.
6 Total costs included maintenance costs and the costs for COPD exacerbations, including respiratory medications and hospitalisations.