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To the Editor: In the meta-analysis by Dr Singh and colleagues,¹ the question was raised regarding biological causality for the increased cardiovascular mortality associated with the long-term use of tiotropium. According to the manufacturer's package insert,² the number of participants with changes from the baseline-corrected QT interval of 30 to 60 msec was higher in the tiotropium group compared with the placebo group in a multicenter, randomized, double-blind trial of 198 patients with COPD. A lack of QTc effects with tiotropium was reported in the publication of that clinical trial; however, in that trial patients with renal impairment were excluded.³

Per the package insert,² tiotropium is well absorbed from the lung and is predominantly excreted renally. Mild renal impairment (creatinine clearance of 50-80 mL /min), typical of older patients, is associated with a 39% increase in the area under the curve from 0 to 4 hours after intravenous infusion of tiotropium.² . . . [Full Text of this Article]

Katherine E. Hodgin, MD
katherine.hodgin@uchsc.edu

James P. Maloney, MD
Department of Pulmonary Sciences and Critical Care Medicine
University of Colorado Hospital
Aurora

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