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How Much Did Biases in the Study of Chronic Obstructive Pulmonary Disease Medications and Mortality Affect the Outcome?
- Todd A. Lee, PharmD, PhD;
- A. Simon Pickard, PhD; and
- David H. Au, MD, MS
- From Hines Veterans Affairs Hospital, Hines, IL 60141; University of Illinois at Chicago, Chicago, IL 60637; and Veterans Affairs Puget Sound Health Care System, Seattle, WA 98174.
IN RESPONSE:
We thank the correspondents for their thoughtful comments. Drs. Suissa and Ernst raise 3 concerns about our article. First, to alleviate concerns that the observed risk for ipratropium and cardiovascular mortality was a result of an increased risk for exacerbations in the case patients, we conducted an analysis restricted to those without an exacerbation in the 180 days before their event date and found a level of risk (odds ratio, 1.45 [CI, 1.14 to 1.85]) similar to the results reported in the article. Second, unmeasured confounding and bias is a possible explanation for the discordant results between the TORCH study and our …
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