Tiotropium in Combination with Placebo, Salmeterol, or Fluticasone–Salmeterol for Chronic Obstructive Pulmonary Disease: Possible Confounding Effect of Treatment Withdrawal?
Authors: Samuel M. Brown
Journal: Annals of Internal Medicine (2007)

Letters18 December 2007Tiotropium in Combination with Placebo, Salmeterol, or Fluticasone–Salmeterol for Chronic Obstructive Pulmonary Disease: Possible Confounding Effect of Treatment Withdrawal?Samuel M. Brown, MDSamuel M. Brown, MDFrom the University of Utah, Salt Lake City, UT 84112.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-147-12-200712180-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Aaron and colleagues (1) present a study designed to answer a clinically relevant question of whether 2 expensive therapies are better than 1 when the individual components seem to be separately efficacious. Unfortunately, the authors failed to consider the extent to which clinical practice had already outstripped the evidence. They report that as many as 63.6% of tiotropium–placebo recipients (the control group) were taking long-acting β-agonists (LABAs), usually in combination with inhaled corticosteroids at the time of enrollment, and perhaps 25% more were taking inhaled corticosteroids without LABAs. In an important sense, this control group thus represented ...References1. Aaron SD, Vandemheen KL, Fergusson D, Maltais F, Bourbeau J, Goldstein R, et al. Tiotropium in combination with placebo, salmeterol, or fluticasone–salmeterol for treatment of chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2007;146:545-55. [PMID: 17310045] LinkGoogle Scholar2. Wouters EF, Postma DS, Fokkens B, Hop WC, Prins J, Kuipers AF, et al. Withdrawal of fluticasone propionate from combined salmeterol/fluticasone treatment in patients with COPD causes immediate and sustained disease deterioration: a randomised controlled trial. Thorax. 2005;60:480-7. [PMID: 15923248] CrossrefMedlineGoogle Scholar3. Campbell M, Eliraz A, Johansson G, Tornling G, Nihlén U, Bengtsson T, et al. Formoterol for maintenance and as-needed treatment of chronic obstructive pulmonary disease. Respir Med. 2005;99:1511-20. [PMID: 16199148] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the University of Utah, Salt Lake City, UT 84112.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTiotropium in Combination with Placebo, Salmeterol, or Fluticasone–Salmeterol for Treatment of Chronic Obstructive Pulmonary Disease Shawn D. Aaron , Katherine L. Vandemheen , Dean Fergusson , François Maltais , Jean Bourbeau , Roger Goldstein , Meyer Balter , Denis O'Donnell , Andrew McIvor , Sat Sharma , Graham Bishop , John Anthony , Robert Cowie , Stephen Field , Andrew Hirsch , Paul Hernandez , Robert Rivington , Jeremy Road , Victor Hoffstein , Richard Hodder , Darcy Marciniuk , David McCormack , George Fox , Gerard Cox , Henry B. Prins , Gordon Ford , Dominique Bleskie , Steve Doucette , Irvin Mayers , Kenneth Chapman , Noe Zamel , Mark FitzGerald , and Tiotropium in Combination with Placebo, Salmeterol, or Fluticasone–Salmeterol for Chronic Obstructive Pulmonary Disease: Possible Confounding Effect of Treatment Withdrawal? Shawn D. Aaron Metrics 18 December 2007Volume 147, Issue 12Page: 882KeywordsChronic obstructive pulmonary diseaseClinical trialsConflicts of interestCorticosteroid therapy ePublished: 18 December 2007 Issue Published: 18 December 2007 CopyrightCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...