RT Journal Article
SR Electronic
T1 Real world effects of COPD medications: a cohort study with validation against results from randomised controlled trials
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2001586
DO 10.1183/13993003.01586-2020
VO 57
IS 3
A1 Wing, Kevin
A1 Williamson, Elizabeth
A1 Carpenter, James R.
A1 Wise, Lesley
A1 Schneeweiss, Sebastian
A1 Smeeth, Liam
A1 Quint, Jennifer K.
A1 Douglas, Ian
YR 2021
UL https://publications.ersnet.org//content/57/3/2001586.abstract
AB Real-world data provide the potential for generating evidence on drug treatment effects in groups excluded from trials, but rigorous, validated methodology for doing so is lacking. We investigated whether non-interventional methods applied to real-world data could reproduce results from the landmark TORCH COPD trial.We performed a historical cohort study (2000–2017) of COPD drug treatment effects in the UK Clinical Practice Research Datalink (CPRD). Two control groups were selected from CPRD by applying TORCH inclusion/exclusion criteria and 1:1 matching to TORCH participants, as follows. Control group 1: people with COPD not prescribed fluticasone propionate (FP)-salmeterol (SAL); control group 2: people with COPD prescribed SAL only. FP-SAL exposed groups were then selected from CPRD by propensity score matching to each control group. Outcomes studied were COPD exacerbations, death from any cause and pneumonia.2652 FP-SAL exposed people were propensity score matched to 2652 FP-SAL unexposed people while 991 FP-SAL exposed people were propensity score matched to 991 SAL exposed people. Exacerbation rate ratio was comparable to TORCH for FP-SAL versus SAL (0.85, 95% CI 0.74–0.97 versus 0.88, 0.81–0.95) but not for FP-SAL versus no FP-SAL (1.30, 1.19–1.42 versus 0.75, 0.69–0.81). In addition, active comparator results were consistent with TORCH for mortality (hazard ratio 0.93, 0.65–1.32 versus 0.93, 0.77–1.13) and pneumonia (risk ratio 1.39, 1.04–1.87 versus 1.47, 1.25–1.73).We obtained very similar results to the TORCH trial for active comparator analyses, but were unable to reproduce placebo-controlled results. Application of these validated methods for active comparator analyses to groups excluded from randomised controlled trials provides a practical way for contributing to the evidence base and supporting COPD treatment decisions.In COPD patients selected from real-world data based on similarity to participants of the TORCH RCT, non-interventional methods generated comparable results to the TORCH analysis of LABA-ICS versus LABA in relation to exacerbations, mortality and pneumonia https://bit.ly/33ky5D0