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Inhaled corticosteroids and mortality in COPD
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  1. P Ernst,
  2. S Suissa
  1. McGill Pharmacoepidemiology Research Unit, McGill University, Montreal, Canada
  1. Correspondence to:
    Dr P Ernst
    McGill Pharmacoepidemiology Research Unit, McGill University, Montreal, Canada; pierre.ernst{at}mcgill.ca

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We read with interest the recent paper by Sin and colleagues1 which, we believe, raises more questions than it answers.

A major concern is the fact that ascertainment of mortality was incomplete for a significant proportion of patients (973/5086), corresponding to 19% of the total (not the reported 12%) who withdrew prematurely from the study. This loss to follow up was more likely to occur in the placebo group. The authors use the ISOLDE study2 to claim that patients who withdrew prematurely were more likely to die, and that therefore the hazard ratio is in fact an underestimate of the benefit of inhaled corticosteroids (ICS). However, the ISOLDE data are themselves contradictory on this point. The claim is based on …

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