Efficacy and safety of tiotropium in COPD patients in primary care: the SPiRiva Usual CarE (SPRUCE) study

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Clinical trials of tiotropium have principally recruited patients from secondary care with more severe chronic obstructive pulmonary disease (COPD), and typically had included limitation of concomitant medication. In primary care, which is the most common setting for COPD management, many patients may have milder disease, and also may take a broad range of concomitant medication. METHODS: This randomised, placebo-controlled, parallel-group, 12-week, 44-centre study investigated the efficacy (trough forced expiratory volume in 1 second [FEV1] response) and safety of additional treatment with once-daily tiotropium 18 mug via the HandiHaler in a primary care COPD population (tiotropium: N = 191, FEV1 = 1.25 L [47.91% predicted]; placebo: N = 183, FEV1 = 1.32 L [49.86% predicted]). Secondary endpoints included: trough forced vital capacity (FVC) response, weekly use of rescue short-acting beta-agonist, and exacerbation of COPD (complex of respiratory symptoms/events of >3 days in duration requiring a change in treatment). Treatment effects were determined using non-parametric analysis. RESULTS: At Week 12, median improvement in trough FEV1 response with tiotropium versus placebo was 0.06 L (p = 0.0102). The improvement was consistent across baseline treatment and COPD severity. Median improvement in FVC at 2, 6 and 12 weeks was 0.12 L (p <0.001). The percentage of patients with > or =1 exacerbation was reduced (tiotropium 9.5%; placebo 17.9%; p = 0.0147), independent of disease severity. Rescue medication usage was significantly reduced in the tiotropium group compared with placebo. Adverse event profile was consistent with previous studies. CONCLUSION: Tiotropium provides additional benefits to usual primary care management in a representative COPD population. TRIAL REGISTRATION: The identifier is: NCT00274079.
Original languageEnglish
Article number45
JournalRespiratory Research
Volume8
Issue number45
DOIs
Publication statusPublished - 2 Jul 2007

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Chronic Obstructive Pulmonary Disease
Primary Health Care
Safety
Forced Expiratory Volume
Placebos
Vital Capacity
Secondary Care
Therapeutics
Disease Management
Tiotropium Bromide
Population
Patient Care
Clinical Trials

Keywords

  • aged
  • bronchodilator agents
  • cohort studies
  • female
  • Great Britain
  • humans
  • male
  • middle aged
  • placebo effect
  • pulmonary disease, chronic obstructive
  • risk assessment
  • risk factors
  • scopolamine derivatives
  • treatment outcome
  • xerostomia

Cite this

Efficacy and safety of tiotropium in COPD patients in primary care : the SPiRiva Usual CarE (SPRUCE) study. / Freeman, Daryl; Lee, Angela; Price, David Brendan.

In: Respiratory Research, Vol. 8, No. 45, 45, 02.07.2007.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Clinical trials of tiotropium have principally recruited patients from secondary care with more severe chronic obstructive pulmonary disease (COPD), and typically had included limitation of concomitant medication. In primary care, which is the most common setting for COPD management, many patients may have milder disease, and also may take a broad range of concomitant medication. METHODS: This randomised, placebo-controlled, parallel-group, 12-week, 44-centre study investigated the efficacy (trough forced expiratory volume in 1 second [FEV1] response) and safety of additional treatment with once-daily tiotropium 18 mug via the HandiHaler in a primary care COPD population (tiotropium: N = 191, FEV1 = 1.25 L [47.91{\%} predicted]; placebo: N = 183, FEV1 = 1.32 L [49.86{\%} predicted]). Secondary endpoints included: trough forced vital capacity (FVC) response, weekly use of rescue short-acting beta-agonist, and exacerbation of COPD (complex of respiratory symptoms/events of >3 days in duration requiring a change in treatment). Treatment effects were determined using non-parametric analysis. RESULTS: At Week 12, median improvement in trough FEV1 response with tiotropium versus placebo was 0.06 L (p = 0.0102). The improvement was consistent across baseline treatment and COPD severity. Median improvement in FVC at 2, 6 and 12 weeks was 0.12 L (p <0.001). The percentage of patients with > or =1 exacerbation was reduced (tiotropium 9.5{\%}; placebo 17.9{\%}; p = 0.0147), independent of disease severity. Rescue medication usage was significantly reduced in the tiotropium group compared with placebo. Adverse event profile was consistent with previous studies. CONCLUSION: Tiotropium provides additional benefits to usual primary care management in a representative COPD population. TRIAL REGISTRATION: The identifier is: NCT00274079.",
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T1 - Efficacy and safety of tiotropium in COPD patients in primary care

T2 - the SPiRiva Usual CarE (SPRUCE) study

AU - Freeman, Daryl

AU - Lee, Angela

AU - Price, David Brendan

PY - 2007/7/2

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N2 - BACKGROUND: Clinical trials of tiotropium have principally recruited patients from secondary care with more severe chronic obstructive pulmonary disease (COPD), and typically had included limitation of concomitant medication. In primary care, which is the most common setting for COPD management, many patients may have milder disease, and also may take a broad range of concomitant medication. METHODS: This randomised, placebo-controlled, parallel-group, 12-week, 44-centre study investigated the efficacy (trough forced expiratory volume in 1 second [FEV1] response) and safety of additional treatment with once-daily tiotropium 18 mug via the HandiHaler in a primary care COPD population (tiotropium: N = 191, FEV1 = 1.25 L [47.91% predicted]; placebo: N = 183, FEV1 = 1.32 L [49.86% predicted]). Secondary endpoints included: trough forced vital capacity (FVC) response, weekly use of rescue short-acting beta-agonist, and exacerbation of COPD (complex of respiratory symptoms/events of >3 days in duration requiring a change in treatment). Treatment effects were determined using non-parametric analysis. RESULTS: At Week 12, median improvement in trough FEV1 response with tiotropium versus placebo was 0.06 L (p = 0.0102). The improvement was consistent across baseline treatment and COPD severity. Median improvement in FVC at 2, 6 and 12 weeks was 0.12 L (p <0.001). The percentage of patients with > or =1 exacerbation was reduced (tiotropium 9.5%; placebo 17.9%; p = 0.0147), independent of disease severity. Rescue medication usage was significantly reduced in the tiotropium group compared with placebo. Adverse event profile was consistent with previous studies. CONCLUSION: Tiotropium provides additional benefits to usual primary care management in a representative COPD population. TRIAL REGISTRATION: The identifier is: NCT00274079.

AB - BACKGROUND: Clinical trials of tiotropium have principally recruited patients from secondary care with more severe chronic obstructive pulmonary disease (COPD), and typically had included limitation of concomitant medication. In primary care, which is the most common setting for COPD management, many patients may have milder disease, and also may take a broad range of concomitant medication. METHODS: This randomised, placebo-controlled, parallel-group, 12-week, 44-centre study investigated the efficacy (trough forced expiratory volume in 1 second [FEV1] response) and safety of additional treatment with once-daily tiotropium 18 mug via the HandiHaler in a primary care COPD population (tiotropium: N = 191, FEV1 = 1.25 L [47.91% predicted]; placebo: N = 183, FEV1 = 1.32 L [49.86% predicted]). Secondary endpoints included: trough forced vital capacity (FVC) response, weekly use of rescue short-acting beta-agonist, and exacerbation of COPD (complex of respiratory symptoms/events of >3 days in duration requiring a change in treatment). Treatment effects were determined using non-parametric analysis. RESULTS: At Week 12, median improvement in trough FEV1 response with tiotropium versus placebo was 0.06 L (p = 0.0102). The improvement was consistent across baseline treatment and COPD severity. Median improvement in FVC at 2, 6 and 12 weeks was 0.12 L (p <0.001). The percentage of patients with > or =1 exacerbation was reduced (tiotropium 9.5%; placebo 17.9%; p = 0.0147), independent of disease severity. Rescue medication usage was significantly reduced in the tiotropium group compared with placebo. Adverse event profile was consistent with previous studies. CONCLUSION: Tiotropium provides additional benefits to usual primary care management in a representative COPD population. TRIAL REGISTRATION: The identifier is: NCT00274079.

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KW - bronchodilator agents

KW - cohort studies

KW - female

KW - Great Britain

KW - humans

KW - male

KW - middle aged

KW - placebo effect

KW - pulmonary disease, chronic obstructive

KW - risk assessment

KW - risk factors

KW - scopolamine derivatives

KW - treatment outcome

KW - xerostomia

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SN - 1465-9921

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ER -