CHEST Guidelines-Methodologic-Issues-With-Comparative-Effectiveness

Methodologic-Issues-With-Comparative-Effectiveness

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The article presents a critique and subsequent response concerning a study on COPD treatment published in CHEST. The critique, authored by Rothnie and Quint, focuses on the methodology used by Suissa et al. to compare the effectiveness of a triple therapy (LAMA-LABA-ICS) against a dual therapy (LAMA-LABA) for treating COPD. The main issue raised is the misclassification of COPD exacerbations due to the definition used by Suissa et al., which relied on new prescriptions for oral corticosteroids. Rothnie and Quint argue that this method underestimates the rate of moderate AECOPD, potentially biasing results in favor of LAMA-LABA. They recommend a composite outcome definition, which includes a combination of antibiotic and oral corticosteroid prescriptions, symptoms, and diagnostic codes. They also criticize the exclusion of patients with asthma, suggesting it may lead to non-generalizable results as 50% of potential COPD patients were excluded.<br /><br />Suissa et al., in response, defend their methodological choices by stating that they focused solely on COPD patients to avoid confounding results with asthma treatments. They repeated their analysis with the proposed composite outcome definition, finding unchanged results. Suissa et al. emphasize that their study, distinct from trials like IMPACT, explains the similar effectiveness between LAMA-LABA-ICS and LAMA-LABA, except in patients with higher eosinophil levels and frequent exacerbations. They argue that including asthma patients in the study could lead to inaccurate interpretations about the true effectiveness of these treatments for COPD. This exchange highlights ongoing concerns with research methodologies in COPD treatment studies, particularly the challenges in accurately classifying exacerbations and patient selection criteria.

Keywords

COPD

exacerbations

triple therapy

dual therapy

methodology

Suissa

Rothnie

Quint

misclassification

asthma