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LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis

International journal of chronic obstructive pulmonary disease, 2017-01, Vol.12, p.907-922 [Peer Reviewed Journal]

COPYRIGHT 2017 Dove Medical Press Limited ;COPYRIGHT 2017 Dove Medical Press Limited ;2017. This work is licensed under https://creativecommons.org/licenses/by-nc/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;2017 Rodrigo et al. This work is published and licensed by Dove Medical Press Limited 2017 ;ISSN: 1178-2005 ;ISSN: 1176-9106 ;EISSN: 1178-2005 ;DOI: 10.2147/copd.s130482 ;PMID: 28360514

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Title:
LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis
Author: Rodrigo, Gustavo J ; Price, David ; Anzueto, Antonio ; Singh, Dave ; Altman, Pablo ; Bader, Giovanni ; Patalano, Francesco ; Fogel, Robert ; Kostikas, Konstantinos
Subjects: Abbreviations ; Administration, Inhalation ; Adrenal Cortex Hormones - administration & dosage ; Adrenal Cortex Hormones - adverse effects ; Adrenergic beta-2 Receptor Agonists - administration & dosage ; Adrenergic beta-2 Receptor Agonists - adverse effects ; Bias ; Bronchodilator agents ; Bronchodilator Agents - administration & dosage ; Bronchodilator Agents - adverse effects ; Chi-Square Distribution ; Chronic obstructive lung disease ; Chronic obstructive pulmonary disease ; Clinical trials ; Comparative analysis ; Complications and side effects ; Confidence intervals ; COPD ; Disease Progression ; Dosage and administration ; Drug Combinations ; Drug therapy ; Dyspnea ; Forced Expiratory Volume ; Humans ; LABA/ICS ; LABA/LAMA combinations ; LAMA ; Lung - drug effects ; Lung - physiopathology ; Lung diseases, Obstructive ; Meta-analysis ; Muscarinic antagonists ; Muscarinic Antagonists - administration & dosage ; Muscarinic Antagonists - adverse effects ; Odds Ratio ; Original Research ; Pneumonia ; Pulmonary Disease, Chronic Obstructive - diagnosis ; Pulmonary Disease, Chronic Obstructive - drug therapy ; Pulmonary Disease, Chronic Obstructive - physiopathology ; Randomized Controlled Trials as Topic ; Recovery of Function ; Respiratory distress syndrome ; Risk Factors ; Smooth muscle ; Steroids ; Systematic review ; Time Factors ; Treatment Outcome
Is Part Of: International journal of chronic obstructive pulmonary disease, 2017-01, Vol.12, p.907-922
Description: Randomized controlled trials (RCTs) indicate that long-acting bronchodilator combinations, such as β -agonist (LABA)/muscarinic antagonist (LAMA), have favorable efficacy compared with commonly used COPD treatments. The objective of this analysis was to compare the efficacy and safety of LABA/LAMA with LAMA or LABA/inhaled corticosteroid (ICS) in adults with stable moderate-to-very-severe COPD. This systematic review and meta-analysis (PubMed/MEDLINE, Embase, Cochrane Library and clinical trial/manufacturer databases) included RCTs comparing ≥12 weeks' LABA/LAMA treatment with LAMA and/or LABA/ICS (approved doses only). Eligible studies were independently selected by two authors using predefined data fields; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Eighteen studies (23 trials) were eligible (N=20,185). LABA/LAMA significantly improved trough forced expiratory volume in 1 second (FEV ) from baseline to week 12 versus both LAMA and LABA/ICS (0.07 L and 0.08 L, <0.0001), with patients more likely to achieve clinically important improvements in FEV of >100 mL (risk ratio [RR]: 1.33, 95% confidence interval [CI]: [1.20, 1.46] and RR: 1.44, 95% CI: [1.33, 1.56], respectively, the number needed to treat being eight and six, respectively). LABA/LAMA improved transitional dyspnea index and St George's Respiratory Questionnaire scores at week 12 versus LAMA (both <0.0001), but not versus LABA/ICS, and reduced rescue medication use versus both ( <0.0001 and =0.001, respectively). LABA/LAMA significantly reduced moderate/severe exacerbation rate compared with LABA/ICS (RR 0.82, 95% CI: [0.75, 0.91]). Adverse event (AE) incidence was no different for LABA/LAMA versus LAMA treatment, but it was lower versus LABA/ICS (RR 0.94, 95% CI: [0.89, 0.99]), including a lower pneumonia risk (RR 0.59, 95% CI: [0.43, 0.81]). LABA/LAMA presented a lower risk for withdrawals due to lack of efficacy versus LAMA (RR: 0.66, 95% CI: [0.51, 0.87]) and due to AEs versus LABA/ICS (RR: 0.83, 95% CI: [0.69, 0.99]). The greater efficacy and comparable safety profiles observed with LABA/LAMA combinations versus LAMA or LABA/ICS support their potential role as first-line treatment options in COPD. These findings are of direct relevance to clinical practice because we included all currently available LABA/LAMAs and comparators, only at doses approved for clinical use.
Publisher: New Zealand: Dove Medical Press Limited
Language: English
Identifier: ISSN: 1178-2005
ISSN: 1176-9106
EISSN: 1178-2005
DOI: 10.2147/copd.s130482
PMID: 28360514
Source: GFMER Free Medical Journals
MEDLINE
PubMed Central
DOVE Medical Press Journals
ProQuest Central
DOAJ Directory of Open Access Journals

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LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis

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