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Management of Patients with COPD: A Comparison of the INSPIRE and TORCH Studies

I read with interest the article by Dr. Wedzicha and colleagues, the INSPIRE study, which compared two different drug treatments for the management of patients with chronic obstructive pulmonary disease (COPD) (1). While the combination treatment of inhaled corticosteroid and long-acting β-agonist lessens mortality compared with a long-acting anticholinergic (6 vs. 3% at 2 yr), it is interesting to compare this trial with the recent TORCH study (2), which compared the combination treatment with each of the individual components and placebo. Although both studies describe similar entry criteria, and the groups of patients appeared to be at a similar age, have the same percentage of current smokers, and have the same FEV₁ percent predicted and St. George's Respiratory Questionnaire score, the overall mortality in the combination-treated group of the two studies appears markedly different.

In the TORCH study, 12.6% of the combination-treated patients were dead at 3 years, or approximately 8% at 2 years, greater than both arms of the INSPIRE study, and more than double that of the combination-treated group in the INSPIRE study. This important difference is only discussed briefly by Wedzicha and coworkers (1), no doubt due to space limitations. While premature withdrawal from the INSPIRE trial, with subsequent death, may explain at least some of this difference, could the authors outline any other reasons for this dramatic difference in mortality between the two studies? Are any further data available?

Peter G. Middleton

Westmead Millennium Institute
and
University of Sydney at Westmead
Westmead, Australia

FOOTNOTES

Conflict of Interest Statement: In the past 3 years, P.G.M. has received less than $2,000 for lectures in symposia sponsored by GlaxoSmithKline.

REFERENCES

1. Wedzicha JA, Calverley PMA, Seemungal TA, Hagan G, Ansari Z, Stockley RA; for the INSPIRE Investigators. The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide. Am J Respir Crit Care Med 2008;177:19–26.[Abstract/Free Full Text]
2. Calverley PMA, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, Yates JC, Vestbo J; for the TORCH Investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007;356:775–789.[Abstract/Free Full Text]

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