Insights into interventions in managing COPD patients: lessons from the TORCH and UPLIFT studies

Abstract

Influencing the progression of COPD has long been an elusive goal of drug therapy. Directly or indirectly, this has again been investigated in two of the largest, long-term drug trials in COPD: Towards a Revolution in COPD Health (TORCH) and Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT). Neither trial achieved statistical significance in their respective primary outcomes; however, both make considerable contributions to understanding of how the progression of COPD may be influenced. The objective of this article is to review the data from these different trials with a view to what can be learnt about the management of COPD. The long-term improvements in lung function, health-related quality of life, and possibly survival from the use of long-acting bronchodilators in these trials suggest an influence on progression of the disease. With the more optimistic view of benefits from drug treatment of COPD that these trials provide, a review of prescribing practices is warranted.

Keywords: FEV1; bronchodilators; fluticasone; inhaled corticosteroids; mortality; salmeterol; tiotropium.

Figure 1

Change in rate of decline in FEV₁ in UPLIFT^® and TORCH, including ceiling effect (possible rate of decline in healthy individuals). Data from the individual trials have been placed on the same axes for illustrative purposes only and do not represent directly comparable data between the trials. Notes: *p = 0.003 vs placebo; ^†p < 0.001 vs placebo. Abbreviations: FEV₁, forced expiratory volume in 1 second.

Figure 2

Change in exacerbation rates by the active treatment groups in UPLIFT^® and TORCH. Data from the individual trials have been placed on the same axes for illustrative purposes only and do not represent directly comparable data between the trials.

Figure 3

Comparison of selected mortality data presented in the TORCH and UPLIFT ^® primary publications., Data from the individual trials have been placed on the same axes for illustrative purposes only and do not represent directly comparable data between the trials. Abbreviations: CI, confidence interval; HR, hazard ratio; SFC, salmeterol and fluticasone in combination.