TORCH
Towards a Revolution in Copd Health

TORCH : A Landmark Study

First Pharmacological intervention to show evidence in impacting mortality after LTOT and smoking cessation
Large study population (n ∼ 6,000 )
Results reconfirm the role of ICS in severe COPD

Primary Objective

The effect of SFC 50/500 µg vs placebo on all-cause mortality over 3 years in patients with moderate-to-severe COPD

Secondary Objectives

The effect of SFC 50/500 ?g on the rate of moderate and severe exacerbations
The effect of SFC 50/500 ?g on quality of life (SGRQ)

Results: Mortality

Absolute difference 2.6%
HR: 0.825; p=0.052

Quality of Life Over 3 Years

Patients receiving SFC had better quality of life (SGRQ total score) at the end of the study than at the beginning

*p = 0.057 vs placebo; †p <0.001 vs placebo; ‡p <0.001 vs placebo, SALM and FP; vertical bars are standard errors SGRQ = St George's Respiratory Questionnaire. A change in score of 4 units is generally regarded as clinically meaningful

Rate of Decline in Lung Function Over 3 Years

SFC significantly reduced the rate of decline in lung function compared with placebo (39 mL/year vs 55 mL/year, difference 16 mL/year p<0.001)
”...SFC decreas[ed] the excess FEV₁ decline attributable to COPD by approximately half.”
“...halving the excess decline in FEV₁ is likely to be clinically important...”
Error bars represent 5% and 95% confidence intervals

The Mortality Benefit with SFC vs Placebo is Supported by Significant Improvements in the Three Pillars of Clinical Management of COPD

TORCH: Conclusions

TORCH is the first study to show a potential survival benefit of pharmacotherapy in COPD patients (with p=0.052 for SFC vs. placebo in terms of all cause mortality at 3 years)
In addition, SFC also decreased exacerbations and improved lung function and improved and sustained quality of life over three years
These were accompanied by a reduction in the rate of decline in lung function in patients taking SFC compared with placebo demonstrating an effect on disease progression
These results demonstrate the clinical efficacy of SFC 50/500 ?g bd in patients with FEV1<60% predicted.