Long-term Tiotropium Bromide Therapy in CF Patients Linked to Improvements in Lung Function Decline

Adult patients with cystic fibrosis (CF) show improvements in lung function decline when treated with a high dosage of tiotropium bromide taken over a long term (24 months).

Patients with cystic fibrosis often succumb to chronic lung disease, the leading cause of death among cystic fibrosis patients. Chronic lung disease is often treated with bronchodilators. The long-acting, inhaled, anticholinergic bronchodilator tiotropium bromide is approved for maintenance therapy in patients with chronic obstructive pulmonary disease (COPD). Administration of tiotropium bromide in COPD patients is associated with improvements in lung function and measures of disease exacerbations.

The study, “Impact of Long-Term Tiotropium Bromide Therapy on Annual Lung Function Decline in Adult Patients with Cystic Fibrosis,” was published in the open access journal PLOS One.

Few randomized placebo-controlled multicenter trials with tiotropium in children and adults with cystic fibrosis tested this therapy administered for less than 12 weeks and testing dosages of up to 5 micrograms (μg). The results showed that improved lung function was detected only when patients were treated with the highest dosage.

Now, a team of researchers tested the effects of tiotropium bromide when administered for 24 months, and at a high dosage of 18 micrograms. Researchers treated adult patients with different cystic fibrosis disease severities with an 18-microgram dosage of inhaled tiotropium, taken daily. The patients’ estimated annual lung function decline is assessed through forced expiratory volume in 1 second (FEV1).

In total, 160 adults were analyzed. Adults patents treated for 24 months with tiotropium bromide had a significantly slower decline of mean annual change of FEV1 compared to placebo controls. In patients with a FEV1 of 70 percent predicted or greater, long-term tiotropium bromide treatment was associated with greater improvements in annual lung function decline.

In conclusion, the results from this retrospective cohort study supported that once-daily inhalation of tiotropium at a higher dose can reduce the rates of lung function decline in a statistically significant manner. Researchers observed, however, no effect of the treatment in the mean annual change of exacerbations in adult cystic fibrosis patients.

Additional studies are still required to fully understand and identify the positive effects of long-term anti-obstructive tiotropium therapy, as well as its safety and tolerability in different groups of cystic fibrosis patients.