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Advair vs. Spiriva: Fewer COPD Deaths
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No Fewer COPD Attacks, but Fewer Deaths With Advair Than Spiriva
Daniel J. DeNoon
Reviewed By Louise Chang, MD
The finding comes from a head-to-head study pitting Advair against Spiriva in the treatment of patients with very serious chronic obstructive pulmonary disease (COPD). GlaxoSmithKline, which makes Advair, funded the study.
Does that mean Advair is the best treatment? Not necessarily. The study was primarily designed to see whether one of the COPD treatments cut disease exacerbations -- occasional attacks. Both treatments were equally effective in preventing COPD attacks.
Overall, 39% of the patients did not have a COPD exacerbation during the two-year study.
But unexpectedly, patients treated with GSK's Advair were only half as likely to die during the two-year study as were patients treated with Pfizer's Spiriva. Three percent of Advair patients and 6% of the Spiriva patients died over the course of the two-year study -- even though patients on Advair were more likely to have suffered a bout of pneumonia.
Nevertheless, even though this difference was statistically significant, the study was not large enough to prove that patients on Advair are less likely to die than are patients on Spiriva.
There were other differences as well. Patients assigned to Spiriva treatment were 29% more likely to drop out of the study. Fewer patients assigned to Advair needed oral steroid treatment, but fewer patients assigned to Spiriva needed antibiotic treatment.
"This provides indirect evidence that these treatments affect apparently similar patients in different ways," note researchers Jadwiga A. Wedzicha, MD, Royal Free & University College Medical School, and colleagues.
The international study enrolled 1,323 patients with severe and very severe COPD. Their average age was 64.
Wedzicha and colleagues note that the different effects of Advair and Spiriva may mean that different drugs may be the best treatment choice for different patients. They recommend further studies to identify factors that may influence the best choice between these two effective COPD drugs.
The findings appear in the January 2008 issue of the American Journal of Respiratory & Critical Care Medicine.
SOURCES: Wedzicha, J.A. American Journal of Respiratory & Critical Care Medicine, January 2008; vol 177: pp 19-26.
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