Obstructive Lung Diseases |

Are Three Little Piglets All the Same? A Nine Month Prospective Cohort Crossover Study Between Tiotropium, Aclidinium, and Glycopyrrhonium With Patients Acting as Their Own Controls FREE TO VIEW

Stefan Rustscheff, MD; Anna Wingerup, MD
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Department of Internal Medicine, Värnamo General Hospital, Värnamo, Sweden

Chest. 2015;148(4_MeetingAbstracts):721A. doi:10.1378/chest.2260928
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: We wanted to investigate if patients with severe COPD would benefit from a trial between tiotropium, aclidinium and glycopyrrhonium We looked for patient preferences, FEV1 rise and Quality of Life with tiotropium as the GOLD standard.

METHODS: A prospective cohort crossover study with patients acting as their own controls, consisting of patients belonging to Värnamo General Hospital with COPD grade 4 as classified by the modified GOLD criteria of 2014. All were on tiotropium delivered through Spiriva Respimat. Base medications were ICS/LABA and/or oral theophylline. Patients were on each substance for three months, assessed by a single doctor for exacerbations, FEV1, inhaler proficiency and a Quality of life index.

RESULTS: Out of 38 patients, 19 preferred to return to tiotropium while 8 out of 34 preferred aclidinium and 11 out of 31 glycopyrrhonium. This was identical to the spirometrical results, where just as many patients had peak FEV1 on their respective inhalers. These results were significant towards the retention of tiotropium. There were no significant differences in exacerbations, with a rate of 32% for tiotropium and aclidinium, and 26% for glycopyrrhonium. A total Quality of life index compared to tiotropium showed that 6% on aclidinium worsened while 9% improved, Glycopyrrhonium results were 19% and 10%. Dyspnea worsened in 12% and improved in 24% in the aclidinium group. The glycopyrrhonium results were 23% and 10%.

CONCLUSIONS: 50% of patients in a severely ill cohort of patients with COPD with a maximum FEV1 of 1.5 l and a mean FEV1 of 0.81 l stable on tiotropium actually wanted to change to either aclidinium or glycopyrrhonium, given the chance to do so, in spite of no differences in exacerbation rates between the groups. 24% on aclidinium noted less dyspnea and 23% on glycopyrrhonium MORE dyspnea. In spite of that, 29% chose glycopyrrhonium as their inhaler of choice, while aclidinium was chosen by 21%.

CLINICAL IMPLICATIONS: In spite of tiotropium being standard therapy in Sweden, at least half of a cohort of severely ill COPD patients, given a choice, chose to switch to either of the two currently available muscarinic antagonist alternatives. There was a positive correlation between lessened dyspnea and the retention of aclidinium, but not for glycopyrrhonium. FEV1 gains were modest. A change of 0.2 l in FEV1 was considered significant. Such a gain was seen in 12% and a loss in 24% in both treatment groups compared to tiotropium. Peak FEV1 remains the best predictor of patient preferences.

DISCLOSURE: The following authors have nothing to disclose: Stefan Rustscheff, Anna Wingerup

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