Combo Treatment Works Best for COPD
Only Small Benefit Seen With Chronic Obstructive Pulmonary Disease Treatment
Feb. 21, 2007-- A promising treatment for chronic obstructive pulmonary
disease (COPD) failed to show a clear survival benefit in a large international
trial, but improvements were seen in patient lung function and overall
The study looked at treatment with Advair Diskus 500/50, which combines an
inhaled corticosteroid (Flovent) and a long-acting beta-agonist (Serevent).
Researchers compared treatment with the combination drug Advair with each of
the therapies alone, and with no treatment, in patients with chronic
obstructive pulmonary disease.
Compared with untreated patients, Advair-treated patients were 17.5% less
likely to die of all causes during the three-year study.
While the reduction fell just short of reaching statistical significance,
the trial’s author tells WebMD he believes the combined therapy can help
patients live longer.
The study is published in the Feb. 22 issue of The New England Journal of
“We came very close [to showing a survival advantage], but we didn’t quite
make it,” says Peter M.A. Calverley, MD.
“We clearly showed that the combined treatment helps prevent disease-related
exacerbations and helps people feel better," he says. "But does it help
them live longer? We can’t say for sure; but we think it does.”
A Leading Killer
COPD, which includes emphysema and chronic bronchitis, is the fourth leading
cause of death in the U.S.
The disease hampers the airflow of the airways, making it hard to
breathe. It generally worsens over time.
Nearly 11 million American have been diagnosed with COPD, but it is widely
believed millions more may have it.
The international study, known as the TORCH trial, included 6,112 patients
in 42 countries who had moderate to severe COPD.
Roughly a quarter of the patients took Advair, which contains the
corticosteroid, fluticasone propionate, and a long-acting beta-antagonist,
The remaining patients were treated with either the inhaled corticosteroid
alone, the long-acting beta-agonist alone, or a placebo.
Beta-agonists like salmeterol work by relaxing the smooth muscles of the
airways, which improves airflow.
Inhaled corticosteroids reduce inflammation, which is thought to play a role
A total of 875 patients died during the three-year study.
Deaths from all causes occurred in 12.6% of the combination treatment group,
13.5% of the group treated with the long-acting beta-agonist alone, 16% of
those treated with the inhaled corticosteroid alone, and 15.2% of the placebo
Compared with no treatment, the combination treatment resulted in
statistically meaningful improvements in lung function and less worsening of
Treatment with inhaled corticosteroids -- either alone or as part of the
combination therapy -- was associated with an increase in pneumonia in the
newly reported study.
Patients treated with either the combination therapy or the inhaled steroids
alone were 60% more likely to be diagnosed with pneumonia. But,
surprisingly, they were no more likely to die or be hospitalized than patients
who did not receive corticosteroids.
“We don’t really know what this means,” Calverley says. “These patients had
more pneumonias, but on average they felt better and had fewer flare-ups of
their disease than [untreated] patients.”