Advair vs. Spiriva: Fewer COPD Deaths
No Fewer COPD Attacks, but Fewer Deaths With Advair Than Spiriva
Dec. 28, 2007 -- Severe COPD patients treated with Advair or Spiriva had the
same rate of COPD attacks, but Advair patients were only half as likely to
The finding comes from a head-to-head study pitting Advair against Spiriva
in the treatment of patients with very serious chronic obstructive pulmonary
disease (COPD). GlaxoSmithKline, which makes Advair, funded the study.
Does that mean Advair is the best treatment? Not necessarily. The study was primarily designed to see
whether one of the COPD treatments cut disease exacerbations -- occasional attacks. Both treatments
were equally effective in preventing COPD attacks.
Overall, 39% of the patients did not have a COPD exacerbation during the
But unexpectedly, patients treated with GSK's Advair were only half as
likely to die during the two-year study as were patients treated with Pfizer's
Spiriva. Three percent of Advair patients and 6% of the Spiriva patients died
over the course of the two-year study -- even though patients on Advair were
more likely to have suffered a bout of pneumonia.
Nevertheless, even though this difference was statistically significant, the
study was not large enough to prove that patients on Advair are less likely to
die than are patients on Spiriva.
There were other differences as well. Patients assigned to Spiriva treatment
were 29% more likely to drop
out of the study. Fewer patients assigned to Advair needed oral steroid
treatment, but fewer patients assigned to Spiriva needed antibiotic
"This provides indirect evidence that these treatments affect apparently
similar patients in different ways," note researchers Jadwiga A. Wedzicha,
MD, Royal Free & University College Medical School, and colleagues.
The international study enrolled 1,323 patients with severe and very severe
COPD. Their average age was 64.
Wedzicha and colleagues note that the different effects of Advair and
Spiriva may mean that different drugs may be the best treatment choice for
different patients. They recommend further studies to identify factors that may
influence the best choice between these two effective COPD drugs.
The findings appear in the January 2008 issue of the American Journal of
Respiratory & Critical Care Medicine.