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?-agonists double death risk

Long-acting ?-agonists more than double the risk of hospitalisations and deaths, even when taken with inhaled steroids, a new study warns.

The researchers insisted the drugs had 'no place at all in the treatment of asthma' and call-ed on drug regulators to consider withdrawing them from the market.

Long-acting ?-agonists increased hospitalisations 2.6-fold, life-threatening exacerbations 1.8-fold and asthma- related deaths 3.5-fold, the meta-analysis found.

Of the 33,826 patients in 19 clinical trials, 54 per cent were taking inhaled steroids.

Even when restricting the analysis to trials where over 75 per cent of patients were on inhaled steroids, long-acting ?-

agonists still more than doubled hospitalisation risk.

Study leader Dr Shelley Salpeter, clinical professor of medicine at Stanford University School of Medicine in California, said: 'The mean steroid use for that subgroup was 90 per cent. This clarifies that inhaled steroids do not significantly reduce the adverse effects.

'I definitely advise doctors to stop using long-acting ?-

agonists. They significantly increase life-threatening exacerbations and deaths and should have no place at all in the treatment of asthma ­ I don't use any ?-agonists in my practice.'

The researchers, whose study was published online by the Annals of Internal Medicine, estimated salmeterol alone could be responsible for four out of five asthma-related deaths in the US.

GlaxoSmithKline, manufacturer of the drug, said this assertion was 'not substantiated by clinical evidence and not consistent with data from the US Centers for Disease Control and Prevention'.

Respiratory experts admitted the evidence for use of the drugs was conflicting (see box).

Dr Steve Holmes, chair of the General Practice Airways Group, said future guidance would need to take the study into account. 'It gives some concern but further analysis is needed.'

Professor Martyn Partridge, professor of respiratory medicine at Imperial College London and Asthma UK's chief medical adviser, advised only using long-acting ?-agonists in patients not fully controlled on steroids.

Divided opinion

Medical world split on long-acting ?-agonists

FOR

Overview of Cochrane systematic reviews concludes 'these reviews support guidelines in the use

of long-acting ?-agonists as additional therapy when asthma is inadequately controlled

by inhaled steroids at

moderate dose'

Goal study finds lower exacerbation rates and improvement in health status with use of salmeterol/ fluticasone in combination

AGAINST

New meta-analysis finds long-acting ?-agonists increase hospitalisations and deaths,

even in those on inhaled

steroids

Smart trial finds 'small, but statistically significant' increases in respiratory-related and asthma-related deaths in patients receiving salmeterol

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