The Efficacy And Long-term Security Of Tiotropium In COPD: A Meta-analysis

Objective: To eveluate the efficacy of tiotropium in COPD and to understand the long-term security .Methods: We searched electronic data base including CNKI (2002-2010) , MEDLINE (2002 - 2010) ,PUBMED(2002 - 2010) and Cochrane Library ( to Dec. 2009) ,using the following MeSH and keyword terms: Tiotropium, Spiriva, COPD, Stroke, Meta-analysis, and more related research data were obtained by contacting corresponding researchers or materials showed in the academic meeting. Make up criteria to select the RCTs. Collect the data from the RCTs for the meta-analysis . Data were retrieved and extracted by two reviewers independently,and were cross- checked. Statistical analysis was performed by using RevMan 5.0.Results: Six trials including 10222 patients were selected to analyze the proportion of patients with COPD exacerbations between tiotropium and control; Six trials including 11090 patients were selected to analyze the proportion of patients with COPD-related hospital admissions between tiotropium and control; Five trials including 10079 patients were selected to analyze the mortality between tiotropium and control; Three trials including 7715 patients were selected to analyze the incidence of stroke between tiotropium and control. The results of meta-analysis showed that the tiotropium reduced the proportion of patients with COPD exacerbations(RR: 0.85;95% CI: 0.76～0.95Z = 2.78,p=0.005)and the proportion of patients with COPD-related hospital admissions (RR: 0.72;95% CI: 0.54～0.97 Z = 2.13,p=0.03)compared with control. Also, tiotropium showed statistically lower total mortality (RR: 0.89;95% CI: 0.79～1.0 Z = 2.04,p =0.04) compared with control. However, there was no statistically difference in the incidence of stroke between the two groups(RR: 1.06;95% CI: 0.79～1.43 Z = 0.38,p =0.7).Conclusions:Dudring over 6 months observation, compared with placebo or other bronchodilators , total mortality and the incidence of AECOPD were decreased.However, results for efficacy and risk of stroke are inconclusive, and larger numbers of RCTs with high quality are needed for further researches.