Drug Combo Improves Survival In Patients With COPD

A combination of two common
medications may help patients with chronic obstructive pulmonary disease
(COPD) live longer. New research presented at CHEST 2006, the 72nd annual
international scientific assembly of the American College of Chest
Physicians (ACCP), shows that when used in combination, inhaled salmeterol
(SAL) and fluticasone propionate (FP) reduced the risk of dying by up to
17.5 percent in patients with COPD. Currently, FP, an inhaled
corticosteroid, and SAL, a long-acting B2-agonist bronchodilator, are used
alone and in combination to treat both asthma and COPD.



"The combination therapy of salmeterol and fluticasone is the first
intervention since oxygen therapy or smoking cessation to show improved
survival in patients with COPD," said study author Bartolome R. Celli, MD,
FCCP, of Caritas-St. Elizabeth's Medical Center, Boston, MA. "The
improvement was comparable with that produced by statins in cardiovascular
mortality. This represents an important step forward in the management of
COPD."



As part of the TOwards a Revolution in COPD Health (TORCH) study,
researchers from the United Kingdom, Denmark, Australia, and the United
States investigated whether the combined therapy of salmeterol and
fluticasone (FSC) would significantly impact survival in patients with
COPD. Patients (n=6,112) with moderate to severe COPD from 42 countries
were included in the 3-year, double-blind trial. Of the patients (76
percent men, mean age 65 years), 1,534 received FP; 1,521 received SAL;
1,533 received FSC; and the remaining patients received a placebo. Results
were clinically significant, showing that FSC reduced the risk of dying at
any time by 18 percent compared with placebo over the 3-year period, with
absolute reduction rates being 15.2 percent and 12.6 percent, respectively.
Secondary endpoints also were significant, including reduction in
exacerbations, improvement in quality of life, and lung function.
Furthermore, there was a trend in the reduction in COPD-related mortality
with FSC vs placebo (6.0% vs 4.7%). Overall, survival was better for
patients on combined therapy than for FP alone. Mortality for the active
combination also was lower than for SAL, but the difference was not
statistically significant.



"We do not know the exact mechanism by which this combined therapy
works better than the separate therapies. We speculate that synergistic
action on cell receptors may lead to less muscle contraction or
inflammation," said Dr. Celli. "Although we do not expect the combination
therapy to replace existing therapies, it will allow greater room for
intervention for health-care providers treating patients with COPD."



"COPD is a progressive and debilitating lung disease most often caused
by smoking," said Mark J. Rosen, MD, FCCP, President of the American
College of Chest Physicians. "There is no cure for COPD, but smoking
cessation and other effective treatments can slow the damage brought about
by smoking. Physicians should encourage their patients who smoke to quit in
order to avoid further lung damage."



CHEST 2006 is the 72nd annual international scientific assembly of the
American College of Chest Physicians, held October 21-26 in Salt Lake City,
UT. ACCP represents 16,500 members who provide clinical respiratory,
critical care, sleep, and cardiothoracic patient care in the United States
and throughout the world. The ACCP's mission is to promote the prevention
and treatment of diseases of the chest through leadership, education,
research, and communication. For more information about the ACCP, please
visit the ACCP Web site at chestnet.


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