Fewer New Tiotropium/Olodaterol Users Escalate to Triple Therapy vs New Tiotropium Monotherapy Users

COPD diagnosis
COPD diagnosis
The researchers’ main goal was to compare real-world time-to-escalation to triple therapy for COPD without asthma among new users of tiotropium/olodaterol vs users of tiotropium monotherapy.

Patients with chronic obstructive pulmonary disorder (COPD) who are new users of tiotropium/olodaterol had fewer escalations to triple therapy compared with new users of tiotropium alone, according to study findings published in Respiratory Research.

In patients with COPD, an extended time to escalation to triple therapy suggests the condition has stabilized and treatment has been effective. This study examined the time to escalation to triple therapy in patients with COPD who were new users of tiotropium/olodaterol (n=1436) or tiotropium monotherapy (n=5352).

Patient data were obtained from a Japanese hospital-based database. Researchers assessed the time it took for patients to escalate to any long-acting muscarinic antagonists/long-acting β2-agonists/inhaled corticosteroid triple therapy.

A total of 7 and 8 escalations to triple therapy were reported in the tiotropium/olodaterol and tiotropium monotherapy groups, respectively. The tiotropium monotherapy group had a numerically lower median time-to-escalation to triple therapy (28 days vs 193 days), but the difference between the 2 groups was not significant (hazard ratio [HR], 0.89; 95% CI, 0.32-2.46).

This finding was replicated in a post hoc analysis that expanded the study period by 1 year (HR, 0.71; 95% Cl, 0.36-1.40). No between-group differences were found in regard to the risks for all-cause inpatient mortality, major adverse cardiovascular events, and first use of home oxygen therapy.

The researchers also found patients who received tiotropium/olodaterol had lower risks of first moderate and/or severe COPD exacerbation compared with the tiotropium monotherapy group, but the difference was not statistically significant.

A limitation of this study was the inclusion of data from the real-world setting, which tends to lack standardized measurements and investigations. The study was also limited by its retrospective design.

Although this study showed a small number of escalation events, the researchers believe it “provides real-world evidence on the management of COPD and on the rate of COPD exacerbation in Japanese patients with COPD.”

Disclosure: This clinical trial was supported by Boehringer Ingelheim. Please see the original reference for a full list of disclosures.


Muro S, Suzuki M, Nakamura S, et al. Real-world effectiveness of early intervention with fixed-dose tiotropium/olodaterol vs tiotropium in Japanese patients with COPD: a high-dimensional propensity score-matched cohort analysis. Respir Res. 2021;22(1):180. doi:10.1186/s12931-021-01776-y