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We would like to thank Dr Vestbo for his comments. We agree that in the Optimal Trial more patients originally randomised to the placebo arm prematurely discontinued study medications, and that many of these patients were subsequently put on open label ICS/LABA products.1 As discussed in our paper, the relative risk reduction decreased from 21% if patients were prematurely excluded once they discontinued study drugs to 15% when an intent to treat analysis was used.2 We agree with Dr Vestbo that our intention …
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Competing interests: None.