Eun-Hye Lim

Indirect Comparison of Exacerbation Frequency Between Aclidinium and Tiotropium in Patients With Chronic Obstructive Pulmonary Disease.

PRS8 IndIRect comPaRISon of exaceRbatIon fRequency between aclIdInIum and tIotRoPIum In PatIentS wIth chRonIc obStRuctIve PulmonaRy dISeaSe Lee H., Choi S.E., Bae E., Lim E.A., Kim J., Park H. Korea University, Yeongi-gun, South Korea objeCtives: The purpose of this study is to compare the frequency of exacerbations between aclidinium and tiotropium in patients with chronic obstructive pulmonary disease (COPD). Methods: Through a systematic literature search in Medline (PubMed), we included randomized controlled trials that evaluated the exacerbation frequency of aclidinium 200μg and 400μg twice a day and tiotropium 18μg once a day regimens compared to placebo. Inclusion criteria were at least 12 weeks of treatment from January 1990 to January 2014, an age over 40, current or former smokers, and diagnosis with moderate to very severe COPD. The main outcome is the frequency of exacerbation. Indirect comparison analysis was performed to estimate the odds ratio of exacerbation between aclidinium and tiotropium. Results: After screening 278 full-text articles, we identified 19 clinical trials that total 19,741 COPD patients were participated: 3 trials of aclidinium 200μg and 400μg BID and 16 trials of tiotropium 18μg QD. tiotropium 18μg was associated with a significant reduction in exacerbation compared with placebo (OR 0.90; 95% CI 0.84 to 0.96). Other two anticholinergic agents showed comparable effects in reducing exacerbation compared with placebo: aclidinium 200μg (OR 0.73; 95% CI 0.53 to 1.01) and aclidinium 400μg (OR 0.72; 95% CI 0.52 to 1.00). Aclidinium 200μg (OR 0.84; 95% CI 0.603-1.167) and aclidinium 400μg (OR 0.83; 95% CI 0.592 -1.156) BID showed the similar frequency of exacerbation to tiotropium 18μg QD. ConClusions: Our study substantiates that tiotropium 18μg provides superior effects on lowering the risk of exacerbation compared with placebo but there was no significant difference in the frequency of exacerbations between aclidinium and tiotropium.