ABSTRACT: Tiotropium Safety and Performance in Respimat® (TIOSPIR®) compared the safety and efficacy of tiotropium Respimat® and tiotropium HandiHaler® in patients with chronic obstructive pulmonary disease (COPD). A prespecified spirometry substudy compared the lung function efficacy between treatment groups.TIOSPIR® was a large-scale, long-term (2.3-year), event-driven, randomized, double-blind, parallel-group trial of 17,135 patients with COPD. In the spirometry substudy, trough forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured at baseline and every 24 weeks for the duration of the trial.The substudy included 1370 patients who received once-daily tiotropium Respimat® 5 ?g (n?=?461), 2.5 ?g (n?=?464), or tiotropium HandiHaler® 18 ?g (n?=?445). Adjusted mean trough FEV1 (average 24-120 weeks) was 1.285, 1.258, and 1.295 L in the Respimat® 5 ?g, 2.5 ?g, and HandiHaler® 18 ?g groups (difference versus HandiHaler® [95 % CI]: -10 [-38, 18] mL for Respimat® 5 ?g and, -37 [-65, -9] mL for Respimat® 2.5 ?g); achieving noninferiority to tiotropium HandiHaler® 18 ?g for tiotropium Respimat® 5 but not for 2.5 ?g (prespecified analysis). Adjusted mean trough FVC was 2.590, 2.544, and 2.593 L in the Respimat® 5 ?g, 2.5 ?g, and HandiHaler® 18 ?g groups. The rates of FEV1 decline over 24 to 120 weeks were similar for the three treatment arms (26, 40, and 34 mL/year for the tiotropium Respimat® 5-?g, 2.5-?g, and HandiHaler® 18-?g groups). The rate of FEV1 decline in GOLD I?+?II patients was greater than in GOLD III?+?IV patients (46 vs. 23 mL/year); as well as in current versus ex-smokers, in patients receiving combination therapies at baseline versus not, and in those experiencing an exacerbation during the study versus not.The TIOSPIR® spirometry substudy showed that tiotropium Respimat® 5 ?g was noninferior to tiotropium HandiHaler® 18 ?g for trough FEV1, but Respimat® 2.5 ?g was not. Tiotropium Respimat® 5 ?g provides similar bronchodilator efficacy to tiotropium HandiHaler® 18 ?g with comparable rates of FEV1 decline. The rate of FEV1 decline varied based on disease severity, with a steeper rate of decline observed in patients with moderate airway obstruction.NCT01126437.
