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  • Title: [Long-term trials assessing pharmacological treatments in COPD: lessons and limitations].
    Author: Marchand E.
    Journal: Rev Mal Respir; 2010 Feb; 27(2):125-40. PubMed ID: 20206061.
    Abstract:
    INTRODUCTION: Several long-term studies designed to assess pharmacological treatments for Chronic Obstructive Pulmonary Disease (COPD) have been published recently. Only such long-term studies allow an accurate analysis of the effect of treatments on criteria of effectiveness such as survival or decline in pulmonary function. A review of these studies is opportune. BACKGROUND: The high drop out rate, which is not a random event, leads to serious methodological problems that are of importance in the interpretation of these studies. Post hoc analysis of both the TORCH and UPLIFT trials suggest a positive effect of long-acting bronchodilators on survival. Up to now, no treatment has convincingly demonstrated an effect on the rate of decline of FEV(1). The treatments evaluated lead to a decrease in exacerbation rates and an improvement in quality of life although the effects of inhaled corticosteroids are subject to methodological concerns. The treatments are all well tolerated. VIEWPOINT: The design of future studies should avoid the withdrawal of treatments at enrolment into a study in order to limit the number of drop outs. CONCLUSION: Long-term studies have made important progress in the knowledge, not only of the effects of the treatments assessed but also of the methodological issues which need to be addressed.
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