Use LABAs only when asthma cannot be controlled otherwise

摘要

When reviewing the value of long acting p2 agonists in the treatment of asthma, Currie and colleagues did not properly report the results of one of the major studies, the Salmeterol Multi-centre Asthma Research Trial (SMART). When salmeterol was approved in the US in 1994, the Food and Drug Administration asked the manufacturerto run a large scale placebo controlled safety trial owingto accumulating concerns about the safety of long acting beta2 agonists, particularly salmeterol. In contrast to Currie and colleagues, SMART showed significant differences in major endpoints in favour of placebo. Accordingto the SMART protocol, an interim analysis was to be performed after 30 000 patients were recruited. The protocol called for SMART to be terminated if evidence was found that salmeterol led to an increase in the primary endpointorasthma related death. Termination criteria were defined as a relative riskof 1.4 forthe primary endpoint and of 3.0 for asthma related deaths. SMART was prematurely terminated in January 2003, and 26355 patients were included in the final analysis.