Extract
The Indacaterol: Switching Non-exacerbating Patients with Moderate COPD From Salmeterol/Fluticasone to Indacaterol (INSTEAD) study, published in the December edition of the European Respiratory Journal, concluded that that “patients with moderate COPD and no exacerbations in the previous year can be switched from salmeterol/fluticasone (SFC) to indacaterol with no efficacy loss” [1]. We would like to respectfully challenge this conclusion (as suggested also by the acronym “INSTEAD”) since, in our opinion, the data presented do not support it. First, the study was designed and powered to address a short-term (12 weeks), physiological question (the primary outcome was non-inferiority of lung function changes (through forced expiratory volume in 1 s (FEV1)). This study design does not allow any inference about the relative clinical positioning of these two therapeutic alternatives at longer term (daily control or future risk, e.g. exacerbation, progression of disease, or mortality).
Abstract
Lung function and relevance on choice of indacaterol or salmeterol/fluticasone combination in moderate COPD patients http://ow.ly/HGOCV
Footnotes
Conflict of interest: Disclosures can be found alongside the online version of this article at erj.ersjournals.com
- Received December 10, 2014.
- Accepted December 11, 2014.
- Copyright ©ERS 2015