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Secondary Outcomes and Peto OR in Meta-analysisSecondary Outcomes and Peto OR in Meta-analysis FREE TO VIEW

Anurag Khera, MD; Taramangalam S. Ramakrishnan, MD
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From the Department of Community Medicine, Armed Forces Medical College.

CORRESPONDENCE TO: Anurag Khera, MD, Department of Community Medicine, Armed Forces Medical College, Pune, 411040, India; e-mail: anuragkhera74@gmail.com


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Chest. 2014;146(6):e212. doi:10.1378/chest.14-1651
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To the Editor:

The recent article in CHEST (June 2014) by Dong et al1 on a systematic review and meta-analysis of randomized controlled trials on the use of inhaled corticosteroids in patients with COPD and the risk of TB and influenza was an interesting read. The article summarizes the odds of TB and influenza in patients with COPD exposed to inhaled corticosteroids. The resultant Peto OR of 2.29 is significant (95% CI, 1.04 -5.03).

Do we need to take the results at face value or with a certain skepticism? The primary outcome of none of the studies included in the meta-analysis was to ascertain the risk of TB and influenza. The sample size calculated for the primary outcome in the selected studies has been used in the present study to answer a question for which the sample size may have been inadequate. The authors have not brought out the rationale addressing this aspect in their article.

The Peto OR was stated to have been used for analyzing OR without continuity correction in view of better CI coverage in rare events. However, the use of Peto OR is subject to the fulfillment of three conditions, viz, a rare event, OR should be close to 1, and both the groups should have similar numbers,2 out of which only the first condition has been fulfilled by the authors.

Weight of individual studies greatly influences the outcome in meta-analysis. In the present study, for the risk of TB, a study by Calverley et al3 has a 76.55% weight, thus influencing the OR.

References

Dong Y-H, Chang C-H, Wu F-LL, et al. Use of inhaled corticosteroids in patients with COPD and the risk of TB and influenza: a systematic review and meta-analysis of randomized controlled trials. Chest. 2014;145(6):1286-1297. [CrossRef] [PubMed]
 
Higgins JPT, Green S., eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2[updated September 2009]. London, England: The Cochrane Collaboration; 2009.
 
Calverley PMA, Anderson JA, Celli B, et al; TORCH investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356(8):775-789. [CrossRef] [PubMed]
 

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References

Dong Y-H, Chang C-H, Wu F-LL, et al. Use of inhaled corticosteroids in patients with COPD and the risk of TB and influenza: a systematic review and meta-analysis of randomized controlled trials. Chest. 2014;145(6):1286-1297. [CrossRef] [PubMed]
 
Higgins JPT, Green S., eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2[updated September 2009]. London, England: The Cochrane Collaboration; 2009.
 
Calverley PMA, Anderson JA, Celli B, et al; TORCH investigators. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356(8):775-789. [CrossRef] [PubMed]
 
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