![]() ![]() ![]() It used a Markov model with states based on GOLD stages 2, 3 and 4 (FEV1 50%–80% predicted, 30%–50% predicted, and <30% predicted, respectively). This study was funded by a manufacturer of tiotropium. Summary of studies included in the economic evidence reviewĮklund 2016 conducted a cost–utility analysis with a lifetime time horizon comparing tiotropium with glycopyrronium in patients with moderate to very severe COPD in the UK. The included studies are presented in full evidence tables in appendix E and are referenced in appendix M. The process of study identification is summarised in the diagram in appendix D. No additional relevant references were found for this review question. These searches, which included articles up to February 2018, returned 3,100 references in total for all the questions included in the update, and these were screened on title and abstract. This took the number of included studies to 35 in total.Ī second set of searches was conducted at the end of the guideline development process for all updated review questions using the original search strategies, to capture papers published whilst the guideline was being developed. On request, Boehringer Ingelheim (BI) provided unpublished data for the group of participants who were not taking a LABA at baseline. The UPLIFT trial (see Tashkin 2008) was not included initially as the study allowed background use of LABAs. This process is presented in a PRISMA diagram in appendix D. Thirty-four papers were included after full text screening: 6 SRs, 3 NMAs and 25 RCTs. RCTs were excluded if they did not meet the criteria specified in the review protocol ( appendix A). These were screened on title and abstract, with 238 papers ordered as potentially relevant Systematic Reviews (SRs), Network Meta-analyses (NMAs) or RCTs. ![]() Additional references were added from the old guideline (6) and from the surveillance report (40) to give 4,254 references after duplicated were removed. No date limits were used for the search as this is a new question, based on evidence identified during routine surveillance. A systematic literature search for randomised controlled trials (RCTs) and systematic reviews (SRs) was conducted and this returned 4,324 references. This review was conducted as part of a larger update of the 2010 NICE COPD guideline (CG101). The outcomes in the PICO were adapted to match the Cochrane review earlier in this evidence review that focused on combinations of LAMA, LABA and LABA/ICS. The review protocol is summarised in Table 13 and detailed in appendix A. This review aims to determine the comparative effectiveness of different LAMAs for managing stable COPD, and to identify which subgroups of people benefit from treatment. Tiotropium is also available in a Respimat device. They are all available as dry powder inhalers and licensed for COPD. There are currently 4 LAMAs that are licensed for use in the UK: aclidinium, glycopyrronium, tiotropium and umeclidinium. LAMAs are also known as long-acting anti-muscarinic agents. However, to date, treatment with any pharmacological agent has not been reflected in a reduction in mortality. This leads to smooth muscle relaxation and dilation of the airways, which can help improve exercise tolerance and improve symptoms in people with COPD. LAMAs work by blocking acetylcholine from binding at the muscarinic acetylcholine receptors, thereby preventing messages going to the parasympathetic nervous system. In people with COPD, airflow obstruction increases the resistance to expiratory flow, causing the airways to close prematurely and incomplete expiration of air, which in turn leads to hyperinflation of the lungs. However, although these drugs may provide some symptomatic relief, they do not prevent disease worsening over time. Breathlessness is one of the main problems associated with COPD and one approach to treatment is the use of bronchodilators, such as LAMAs and long-acting beta agonists (LABAs), with some use of inhaled corticosteroids (ICS). ![]()
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