Regional Differences in Rate of FEV1 decline in COPD: Lessons from SUMMIT

A publication by Zhou et al. , who studied 841 patients from China with mild to moderate COPD (GOLD stage I and II) for two years, documented a 22 mL·year−1 beneficial effect of tiotropium compared with placebo on rate of forced expiratory volume in 1 s (FEV1) [1]. effect was over three times larger than the 6 mL·year−1 (95% CI 1, 11 mL·year−1) reported by Decramer et al. in the 2739 GOLD stage II patients from the four-year UPLIFT trial [2]. We hypothesised that the large difference in results in patients with COPD with similar degree of airflow limitation at study entry, could be related to regional differences in response to similar pharmacological treatment. To test this hypothesis, we investigated the regional differences in FEV1 decline in patients in the COPD Study to Understand Mortality and MorbidITy (SUMMIT), all of whom had spirometric GOLD stage II at enrollment [3].Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Bartolome R. CelliConflict of interest: JA is an employee of and owns shares in GSK.Conflict of interest: Dr. Brook reports personal fees from GSK, during the conduct of the study.Conflict of interest: PMAC has advised Boehringer Ingelheim, GSK, AstraZeneca and Takeda on the design and conduct of clinical trials and has spoken at meetings sponsored by these companies and by Novartis. He has no stock holdings in any pharmaceutical company or connection with the tobacco industry.Conflict of interest: NJC is employed by Veramed Ltd, a Contract Research Organisation undertaking contracted statistical analyses of respiratory studies funded by GSK.Conflict of interest: CC is an employee of and owns shares in GSK.Conflict of interest: Dr. Martinez reports non-financial support from GSK, during the conduct of the study; personal fees from Continuing Education, personal fees from Forest Laboratories, other from Janssen, personal fees from GlaxoSmithKline, personal fees from Nycomed/Takeda, personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Bellerophon (formerly Ikaria), personal fees from Genentech, personal fees from Novartis, personal fees from Pearl, personal fees from Roche, personal fees from Sunovion, personal fees from Theravance, personal fees from CME Incite, personal fees from Annenberg Center for Health Sciences at Eisenhower, personal fees from Integritas, personal fees from InThought, personal fees from National Association for Continuing Education, personal fees from Paradigm Medical Communications, LLC, personal fees from PeerVoice, personal fees from UpToDate, personal fees from Haymarket Communications, personal fees from Western Society of Allergy and Immunology, from Proterixbio (formerly Bioscale), personal fees from Unity Biotechnology, personal fees from ConCert Pharmaceuticals, personal fees from Lucid, personal fees from Methodist Hospital, personal fees from Columbia University, personal fees from Prime Healthcare Ltd, personal fees from WebMD, personal fees from PeerView Network, personal fees from California Society of Allergy and Immunology, personal fees from Chiesi, personal fees from Puerto Rico Thoracic Society, outside the submitted work.Conflict of interest: Dr. Newby reports grants and personal fees from GSK, during the conduct of the study.Conflict of interest: JCY is an employee of and owns shares in GSK.Conflict of interest: Dr. Vestbo reports personal fees from GlaxoSmithKline, during the conduct of the study; personal fees from GlaxoSmithKline, personal fees from Chiesi Pharmaceuticals, personal fees from Boehringer-Ingelheim, personal fees from Novartis, personal fees from AstraZeneca, outside the submitted work.