CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee

Lorcan P McGarvey¹, Matthias John², Julie A Anderson³, Michael Zvarich⁴, Robert A Wise⁵

¹ The Queen’s University of Belfast, Belfast, UK
² Respiratory Medicine, Barmer Ostseeklinik, Prerow, Germany
³ GlaxoSmithKline, Greenford, UK
⁴ GlazoSmithKline, Research Triangle Park, North Carolina, USA
⁵ Johns Hopkins University, Baltimore, Maryland, USA

Correspondence to:
Dr Lorcan P McGarvey
The Queen’s University of Belfast, Grosvenor Road, Belfast BT12 6BJ, UK;l.mcgarvey{at}qub.ac.uk

Background: TORCH (Towards a Revolution in COPD Health) is an international multicentre, randomised, placebo-controlled clinical trial of inhaled fluticasone propionate/salmeterol combination treatment and its monotherapy components for maintenance treatment of moderately to severely impaired patients with chronic obstructive pulmonary disease (COPD). The primary outcome is all-cause mortality. Cause-specific mortality and deaths related to COPD are additional outcome measures, but systematic methods for ascertainment of these outcomes have not previously been described.

Methods: A Clinical Endpoint Committee (CEC) was tasked with categorising the cause of death and the relationship of deaths to COPD in a systematic, unbiased and independent manner. The key elements of the operation of the committee were the use of predefined principles of operation and definitions of cause of death and COPD-relatedness; the independent review of cases by all members with development of a consensus opinion; and a substantial infrastructure to collect medical information.

Results: 911 deaths were reviewed and consensus was reached in all. Cause-specific mortality was: cardiovascular 27%, respiratory 35%, cancer 21%, other 10% and unknown 8%. 40% of deaths were definitely or probably related to COPD. Adjudications were identical in 83% of blindly re-adjudicated cases ( = 0.80). COPD-relatedness was reproduced 84% of the time ( = 0.73). The CEC adjudication was equivalent to the primary cause of death recorded by the site investigator in 52% of cases.

Conclusion: A CEC can provide standardised, reliable and informative adjudication of COPD mortality that provides information which frequently differs from data collected from assessment by site investigators.

Abbreviations: CEC, Clinical Endpoint Committee; COPD, chronic obstructive pulmonary disease; TORCH, Towards a Revolution in COPD Health

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