Article Text

Safety and efficacy of tiotropium in patients switching from HandiHaler to Respimat in the TIOSPIR trial
  1. Ronald Dahl1,
  2. Peter M A Calverley2,
  3. Antonio Anzueto3,
  4. Norbert Metzdorf4,
  5. Andy Fowler5,
  6. Achim Mueller6,
  7. Robert Wise7,
  8. Daniel Dusser8
  1. 1Allergy Centre, Odense University Hospital, Odense C, Denmark
  2. 2Clinical Science Centre (Aintree Campus), Institute of Ageing and Chronic Disease, University Hospital Aintree, Liverpool, UK
  3. 3Pulmonary/Critical Care Department, University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, Texas, USA
  4. 4TA Respiratory Diseases, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany
  5. 5Clinical Research, Boehringer Ingelheim Pharma Ltd, Bracknell, UK
  6. 6Biometrics and Data Management, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach an der Riss, Germany
  7. 7Johns Hopkins Asthma & Allergy Center, Baltimore, Maryland, USA
  8. 8Department of Pneumology, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
  1. Correspondence to Professor Ronald Dahl; Ronald.dahl2{at}


Objectives This post hoc analysis of TIOtropium Safety and Performance In Respimat (TIOSPIR) evaluated safety and exacerbation efficacy in patients with stable (≥2 months) use of tiotropium HandiHaler 18 µg (HH18) prior to study entry, to evaluate whether there was a difference in risk for patients who switched from HH18 to tiotropium Respimat 2.5 µg (R2.5) or 5 µg (R5).

Setting TIOSPIR (n=17 135) was an international, Phase IIIb/IV, randomised, double-blind, parallel-group, event-driven trial.

Participants Patients from TIOSPIR with chronic obstructive pulmonary disease (COPD) and postbronchodilator ratio of forced expiratory volume in 1 s to forced vital capacity ≤0.70, receiving HH18 before study entry, were analysed (n=2784).

Interventions Patients were randomised to once-daily tiotropium R2.5 (n=914), R5 (n=918) or HH18 (n=952) for 2–3 years.

Primary and secondary outcome measures Primary outcomes: time to death (safety) and time to first COPD exacerbation (efficacy). Secondary outcomes: number of exacerbations and time to first major adverse cardiovascular event (MACE).

Results Baseline characteristics were similar in all groups. Respimat had a similar mortality risk versus HH18 (vital status follow-up, HR; 95% CI R2.5: 0.87; 0.64 to 1.17; R5: 0.79; 0.58 to 1.07) with no significant differences in the risk and rates of exacerbations and severe exacerbations across treatment groups. Risk of MACE and fatal MACE was similar for Respimat versus HH18 (HR; 95% CI MACE R2.5: 0.73; 0.47 to 1.15; R5: 0.69; 0.44 to 1.08; fatal MACE R2.5: 0.57; 0.27 to 1.19; R5: 0.67; 0.33 to 1.34). Overall risk of a fatal event (on treatment) was lower for R5 versus HH18 (HR; 95% CI R2.5: 0.78; 0.55 to 1.09; R5: 0.62; 0.43 to 0.89).

Conclusions This analysis indicates that it is safe to switch patients from tiotropium HandiHaler to tiotropium Respimat, and that the efficacy is maintained over the switch.

Trial registration number NCT01126437; Post-results.

  • Tiotropium
  • COPD
  • Respimat®
  • HandiHaler®
  • Switching
  • Efficacy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.