Tiotropium - ein langwirksames, inhalatives Anticholinergikum zur Therapie der chronisch-obstruktiven Lungenerkrankung (COPD)

Zusammenfassung

Anticholinergika sind Mittel der ersten Wahl zur Therapie der COPD. Tiotropium (Ba 679 Br, Spiriva®) ist ein langwirksames inhalatives Anticholinergikum für die einmal tägliche bronchodilatative Behandlung der COPD. Tiotropium ist ein langwirksamer Antagonist pulmonaler M1- und M3-Muskarinrezeptoren, der nach einmaliger Inhalation eine dosisabhängige Bronchodilatation und Bronchoprotektion gegenüber konstriktorischen Stimuli wie Methacholin über mehr als 24 Stunden bewirkt. Klinische Studien mit Tiotropium bei Patienten mit COPD über Behandlungszeiträume von bis zu einem Jahr dokumentieren eine anhaltende Bronchodilatation sowie eine Verbesserung von statischen und dynamischen Lungenfunktionsparametern, Symptomen körperlicher Leistungsfähigkeit und Lebensqualität gegenüber Plazebo und Ipratropium. Darüber hinaus weisen einzelne Untersuchungen darauf hin, dass die Behandlung mit Tiotropium zu einer Reduktion der Exazerbationshäufigkeit und Hospitalisierungen bei COPD-Patienten führt. Ersten vergleichenden klinischen Prüfungen zufolge könnte Tiotropium im Hinblick auf bronchodilatatorische Potenz und Symptomkontrolle derzeit verfügbaren langwirksamen Therapien überlegen sein. Außer einer höheren Inzidenz von Mundtrockenheit entspricht das Nebenwirkungspotential weitgehend dem von Ipratropium. Zusammenfassend legen die bisherigen Ergebnisse nahe, dass Tiotropium die Voraussetzungen für einen inhalativen Bronchodilatator der ersten Wahl bei Patienten mit COPD erfüllt.

Abstract

Anticholinergics are agents of first choice for the symptomatic treatment of patients with COPD. Tiotropium (Ba 679 BR, Spiriva®) is a long-acting inhaled anticholinergic designed for once-daily bronchodilator treatment of COPD. Tiotropium is a selective antagonist of pulmonary M1 and M3 muscarinic receptor subtypes, that produces a long-lasting (24 hours), dose-dependent bronchodilation and bronchoprotection against constrictive stimuli, e. g. methacholine, following inhalation of single doses. Clinical trials with tiotropium in COPD patients over a maximum treatment duration of one year have confirmed a persisting bronchodilator effect of tiotropium compared with placebo and ipratropium, as well as meaningful clinical improvements in lung function, hyperinflation, exercise tolerance, symptom control and quality of life. Moreover, recent trials indicate that treatment with tiotropium also reduces the frequency of COPD exacerbations and hospitalizations. Comparative trials further suggest that the bronchodilator potency of tiotropium may be superior to those of available COPD treatments. Besides a higher incidence of dry mouth, the side effect profile was comparable to ipratropium bromide. In conclusion, present clinical data suggest that tiotropium has the potential of a first-line treatment for patients with COPD.

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