How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome?
Authors: Samy Suissa
Journal: Annals of Internal Medicine (2009)

Letters17 March 2009How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome?Samy Suissa, PhD and Pierre Ernst, MD, MScSamy Suissa, PhDFrom Jewish General Hospital, Montréal, Québec H3T 1E2, Canada.Search for more papers by this author and Pierre Ernst, MD, MScFrom Jewish General Hospital, Montréal, Québec H3T 1E2, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-6-200903170-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Lee and colleagues (1), using an observational study design, report that the use of ipratropium is associated with a 34% increase in the risk for cardiovascular death and that the use of inhaled corticosteroids (ICSs) is associated with a 20% reduction in all-cause mortality in patients with chronic obstructive pulmonary disease (COPD). Some methodological considerations should be addressed in judging the validity of these findings.The excess risk for cardiovascular death seen with ipratropium (odds ratio, 1.34 [95% CI, 1.22 to 1.47]) may be due to the marked imbalance between case patients and control participants in the ...References1. Lee TA, Pickard AS, Au DH, Bartle B, Weiss KB. Risk for death associated with medications for recently diagnosed chronic obstructive pulmonary disease. Ann Intern Med. 2008;149:380-90. [PMID: 18794557] LinkGoogle Scholar2. Soler-Cataluña JJ, Martínez-García MA, Román Sánchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60:925-31. [PMID: 16055622] CrossrefMedlineGoogle Scholar3. Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, et al; TORCH investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356:775-89. [PMID: 17314337] CrossrefMedlineGoogle Scholar4. Suissa S. Immeasurable time bias in observational studies of drug effects on mortality. Am J Epidemiol. 2008;168:329-35. [PMID: 18515793] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Samy Suissa, PhD; Pierre Ernst, MD, MScAffiliations: From Jewish General Hospital, Montréal, Québec H3T 1E2, Canada.Disclosures:Grants received: S. Suissa (AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Pfizer), P. Ernst (AstraZeneca, GlaxoSmithKline, Novartis, Merck & Co., Nycomed). PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRisk for Death Associated with Medications for Recently Diagnosed Chronic Obstructive Pulmonary Disease Todd A. Lee , A. Simon Pickard , David H. Au , Brian Bartle , and Kevin B. Weiss How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome? Nicholas J. Gross How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome? Takeharu Koga , Tomoko Kamimura , and Munetsugu Nishimura How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome? Todd A. Lee , A. Simon Pickard , and David H. Au Metrics Cited byImpacto de los estudios de eficacia y mortalidad (TORCH y UPLIFT) en el tratamiento broncodilatador de la EPOC 17 March 2009Volume 150, Issue 6Page: 425-426KeywordsCardiovascular disease riskChronic obstructive pulmonary diseaseDrugsHospitalizationsMortalityObservational studiesOdds ratioOutpatientsRisk managementStatistical data ePublished: 17 March 2009 Issue Published: 17 March 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...