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Inhaled tiotropium bromide and risk of stroke
Author(s) -
Grosso Anthony,
Douglas Ian,
Hingorani Aroon D.,
MacAllister Raymond,
Hubbard Richard,
Smeeth Liam
Publication year - 2009
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2009.03517.x
Subject(s) - tiotropium bromide , medicine , ipratropium bromide , stroke (engine) , salmeterol , rate ratio , confounding , confidence interval , fluticasone propionate , asthma , inhalation , anesthesia , bronchodilator , lung function , mechanical engineering , lung , engineering
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Conflicting studies have raised uncertainty over the vascular effects of the long‐acting anticholinergic, tiotropium bromide. WHAT THIS STUDY ADDS • Our results show no increased risk of stroke with tiotropium bromide, or with inhaled anticholinergics in general. AIMS A recent communication from the United States Food and Drug Administration highlighted a possible increased risk of stroke associated with use of the relatively new inhaled anticholinergic drug, tiotropium bromide. Using the United Kingdom General Practice Research Database, we set out to assess the risk of stroke in individuals exposed to inhaled tiotropium bromide and two other inhaled treatments for airways disease. METHODS We used the self‐controlled case‐series that reduces confounding and minimizes the potential for biases in the quantification of risk estimates. RESULTS Of 1043 people with a diagnosis of incident stroke who had had at least one prescription for tiotropium bromide, 980 satisfied inclusion criteria. The age‐adjusted incidence rate ratio for all‐cause stoke in individuals exposed to tiotropium bromide ( n = 980), ipratropium bromide ( n = 4181) and fluticasone propionate/salmeterol xinafoate ( n = 1000) was 1.1 [95% confidence interval (CI) 0.9, 1.3], 0.8 (95% CI 0.7, 0.9) and 1.0 (95% CI 0.9, 1.2), respectively. CONCLUSIONS We found no evidence of an increased risk of all‐cause stroke for individuals exposed to commonly prescribed inhaled treatments for chronic obstructive pulmonary disease.