The following is a summary of “Tiotropium reduces clinically important deterioration in patients with mild-to-moderate chronic obstructive pulmonary disease: A post hoc analysis of the Tie-COPD study,” published in the February 2024 issue of Pulmonology by Wu, et al.

Clinically important deterioration (CID) is a composite endpoint for assessing the multifaceted progression of chronic obstructive pulmonary disease (COPD). While tiotropium has demonstrated efficacy in improving lung function and reducing COPD exacerbations in patients with mild-to-moderate COPD, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 or 2, its impact on CID risk in this population remains uncertain.

In the post hoc analysis of the 24-month Tie-COPD study comparing 18 μg tiotropium with placebo in patients with mild-to-moderate COPD, CID was defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 s, an increase of ≥2 units in COPD Assessment Test (CAT) score, or a moderate-to-severe exacerbation. The first occurrence of these events was recorded as the time of the first CID. Subgroup analyses were conducted based on CAT score, modified Medical Research Council (mMRC) dyspnea score, and GOLD stage at baseline.

Out of 841 randomized patients, 771 were included in the full analysis set, with 643 patients (83.4%) experiencing at least one CID event. Tiotropium significantly reduced CID risk and delayed the time to first CID compared with placebo (adjusted hazard ratio = 0.58, 95% CI = 0.49–0.68, P < 0.001). Significant reductions in CID risk were also observed across various subgroups, including patients with a CAT score <10, mMRC score <2, and those classified with mild COPD.

The findings indicated that tiotropium mitigates CID risk in patients with mild-to-moderate COPD, extending to individuals with fewer respiratory symptoms or milder disease severity. It underscored the effectiveness of tiotropium in managing COPD patients with mild disease presentations.

Reference: resmedjournal.com/article/S0954-6111(24)00001-5/abstract