Meta-analysis concludes salmeterol increases risk of death

January 01, 0001

Meta-analysis concludes salmeterol increases risk of death

Concerns have been raised about long-acting beta agonist may increase deaths in asthmatics. These New Zealand researchers conducted a meta- analysis of randomised controlled clinical trials from the GlaxoSmithKline database that compared salmeterol with other treatments in asthma. The Peto one-step method was used to determine the overall mortality risk and in data subsets based on concomitant inhaled corticosteroid use.

The authors found: "There were 35 asthma deaths in 215 studies with 106?575 subjects. Two studies (SMART and SNS) contributed 30/35 (86%) asthma deaths, the overall findings largely reflecting the characteristics of these studies. The odds ratio for risk of asthma mortality with salmeterol was 2.7. In 54 placebo controlled studies the risk of death from asthma in patients not prescribed ICS was 7.3. In 127 studies in which patients were prescribed ICS, the risk of asthma death was 2.1. In 63 studies in which patients were randomised to receive the combination salmeterol/fluticasone propionate inhaler or ICS, there were no asthma deaths among 22?600 patients."

The authors concluded: "Salmeterol monotherapy in asthma increases the risk of asthma mortality and this risk is reduced with concomitant ICS therapy. There is no evidence that combination salmeterol/fluticasone propionate therapy is associated with an increased risk of asthma mortality, although this interpretation is limited by the low statistical power of available studies."

This important study raised significant doubts on the role of salmeterol as monotherapy for asthma. Salmeterol combined with inhaled corticosteroids appears to be safe, but that portion of the study was underpowered.

For the full abstract, click here.

Thorax 65:39-43, January 2010 © 2010 BMJ
Meta-analysis of the risk of mortality with salmeterol and the effect of concomitant inhaled corticosteroid therapy. M Weatherall, M Wijesinghe, K Perrin2, M Harwood, R Beasley. Correspondence to R Beasley: [email protected]

Category: R. Respiratory. Keywords: salmeterol, long acting beta agonist, asthma, mortality, inhaled corticosteroids, meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 10 February 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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