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Abstract
Rationale
Exacerbations of COPD are managed differently, but whether treatment of one exacerbation predicts the likelihood of subsequent events is unknown.
Objective
We examined whether the treatment given for exacerbations predicted subsequent outcomes.
Methods
This was a post-hoc analysis of 17,135 patients with COPD from TIOtropium Safety and Performance In Respimat® (TIOSPIR®). Patients treated with tiotropium with one or more moderate to severe exacerbations on study were analyzed using descriptive statistics, logistic and Cox regression analysis, and Kaplan–Meier plots.
Results
Of 8,061 patients with moderate to severe exacerbation(s), demographics were similar across patients with exacerbations treated with antibiotics and/or steroids or hospitalization. Exacerbations treated with systemic corticosteroids alone or in combination with antibiotics had the highest risk of subsequent exacerbation (HR: 1.21, P=0.0004 and HR: 1.33, P<0.0001, respectively), and a greater risk of having a hospitalized (severe) exacerbation (HR: 1.59 and 1.63, P<0.0001, respectively) or death (HR: 1.50, P=0.0059 and HR: 1.47, P=0.0002, respectively) compared with exacerbations treated with antibiotics alone. Initial hospitalization led to the highest risk of subsequent hospitalization (all-cause or COPD related [severe exacerbation], HR: 3.35 and 4.31, P<0.0001, respectively) or death (all-cause or COPD related, HR: 3.53 and 5.54, P<0.0001, respectively) versus antibiotics alone.
Conclusion
These data indicate that the way exacerbations are treated initially is a useful guide to the patient’s subsequent clinical course. Factors that clinicians consider when making treatment choices require further clarification.
Video abstract
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Supplementary material
Table S1 Time to subsequent event adjusted for inhaled corticosteroid use and exacerbation history
Acknowledgments
Writing assistance was provided by Sarah J Petit and Jennifer C Fuchs of PAREXEL and Claire Scofield of MediTech Media, and was funded by Boehringer Ingelheim.
Author contributions
All authors confirm involvement in the conception, hypotheses delineation, and design of the study; acquisition, analysis, or interpretation of the data; writing or substantial involvement in the article’s revision prior to submission; and agree to be accountable for all aspects of the work.
Disclosure
Outside of the submitted work, PMAC reports receiving research grants from GlaxoSmithKline and Takeda; personal fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmith-Kline, Novartis, and Takeda; and nonfinancial support from Boehringer Ingelheim. ARA reports receiving consulting fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Novartis; and grant support from GlaxoSmithKline. DD reports receiving consulting fees, lecture fees, and payment for the development of educational activities from Boehringer Ingelheim, Chiesi, Dey Pharma, Novartis, Nycomed, and Pfizer. RAW reports receiving consulting fees from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, ContraFect, GlaxoSmithKline, Janssen, Mylan, Novartis, Pfizer, Pulmonx, Roche, Spiration, Sunovion, Teva, Theravance, Verona, and Vertex; and grant support from Boeh-ringer Ingelheim, GlaxoSmithKline, and Pearl Therapeutics. AM and NM are employees of Boehringer Ingelheim. The authors report no other conflicts of interest in this work.