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TORCH: Towards a Revolution in COPD Health? Not really.
Last month, the long-awaited results of the TORCH study of Advair (aka Seretide outside the U.S.)(TM) for patients with moderate to severe COPD were published, but were no doubt disappointing to patients with COPD and investors who own GSK stock. Optimists spun the results as "positive" with a 17% relative reduction in death rates for those taking the combination inhaler for 3 years when compared to those taking the placebo inhaler. However, the absolute difference in deaths during the 3 years from any and all causes was only 2.6% (12.6% vs 15.2%) and this small difference was not statistically significant.An Advair Diskus 500/50mcg (the high dose used by the TORCH study) costs about $270 per month. The drug was associated with a lower hospitalization rate for COPD exacerbations, but 32 patients (or their insurers) would each have to pay about $3200 per year (over $100,000 total) to prevent just one of these hospitalizations.
But doesn't taking the combo inhaler make the patients feel better? Well, after taking Advair for one year, about half of them did generally feel noticably better than those taking the placebo inhaler, according to scores on a standardized COPD questionnaire (St. Georges). However, over the next two years, the disease progressed in all patients as their lung function fell further and they became more short of breath. Those taking the inhaled corticosteroid (fluticasone), either alone or in the combo inhaler, were also significantly more likely to get pneumonia (a serious side-effect). I'm personally not as optimistic (or biased) as my colleagues who were paid to participate in the study, one of whom said, "We clearly showed that the combined treatment helps prevent disease-related exacerbations and helps people feel better. But does it help them live longer? We can't say for sure; but we think it does."
About half of the patients had been taking a COPD inhaler before they entered the study, so it's not surprising that over six billion dollars was spent on Advair inhalers last year (for asthma or COPD), plus billions for Spiriva or Atrovent COPD inhalers.
But doesn't taking the combo inhaler make the patients feel better? Well, after taking Advair for one year, about half of them did generally feel noticably better than those taking the placebo inhaler, according to scores on a standardized COPD questionnaire (St. Georges). However, over the next two years, the disease progressed in all patients as their lung function fell further and they became more short of breath. Those taking the inhaled corticosteroid (fluticasone), either alone or in the combo inhaler, were also significantly more likely to get pneumonia (a serious side-effect). I'm personally not as optimistic (or biased) as my colleagues who were paid to participate in the study, one of whom said, "We clearly showed that the combined treatment helps prevent disease-related exacerbations and helps people feel better. But does it help them live longer? We can't say for sure; but we think it does."
About half of the patients had been taking a COPD inhaler before they entered the study, so it's not surprising that over six billion dollars was spent on Advair inhalers last year (for asthma or COPD), plus billions for Spiriva or Atrovent COPD inhalers.
I worry that patients believe that these inhalers are "curing" their lung disease and that they don't have to take the effort to stop smoking. Forty percent of the 6000 COPD patients in the TORCH study were still smoking, despite their advanced lung disease due to their habit. Sadly, I think that doctors are taking the easy ten second "solution" of writing a prescription for an expensive inhaler instead of the time-consuming counseling over several visits needed to help a nicotine addict to quit. Smoking cessation is the only intervention proven to slow the progression of COPD. It has been proven several times that inhalers are not the cure for COPD.
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Technorati Tags: COPD, chronic obstructive pulmonary disease, Advair, smoking cessation, healh-and-wellness
Labels: COPD
