Comparative efficacy of inhaled medications (ICS/LABA, LAMA, LAMA/LABA and SAMA) for COPD: a systematic review and network meta-analysis
| Autor: | Ling Eng Tan, Gerald Seng Wee Chua, Mohamed Ismail Abdul Aziz, Ping-Tee Tan, Fiona Pearce, David Bin-Chia Wu, Liang Lin, Kwong Ng |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Network Meta-Analysis Respiratory System Agents Review mixed treatment comparison Muscarinic Antagonists chronic obstructive pulmonary disease 03 medical and health sciences chemistry.chemical_compound Pulmonary Disease Chronic Obstructive 0302 clinical medicine Internal medicine frequentist meta-analysis Forced Expiratory Volume Administration Inhalation medicine Humans 030212 general & internal medicine anticholinergics Adrenergic beta-2 Receptor Agonists Fluticasone Randomized Controlled Trials as Topic COPD biology business.industry indirect treatment comparison Olodaterol General Medicine Lama biology.organism_classification medicine.disease respiratory tract diseases Treatment Outcome 030228 respiratory system chemistry Indacaterol Vilanterol Formoterol Salmeterol business hormones hormone substitutes and hormone antagonists medicine.drug |
| Zdroj: | International Journal of Chronic Obstructive Pulmonary Disease |
| ISSN: | 1178-2005 1176-9106 |
| Popis: | Purpose To assess the comparative efficacy of short-acting muscarinic antagonists (SAMAs), long-acting muscarinic antagonists (LAMAs), LAMA in combination with long-acting beta-agonists (LABAs; LAMA/LABAs) and inhaled corticosteroids (ICS) in combination with LABA (ICS/LABAs) for the maintenance treatment of COPD. Materials and methods We systematically reviewed 74 randomized controlled trials (74,832 participants) published up to 15 November 2017, which compared any of the interventions (SAMA [ipratropium], LAMA [aclidinium, glycopyrronium, tiotropium, umeclidinium], LAMA/LABA [aclidinium/formoterol, indacaterol/glycopyrronium, tiotropium/olodaterol, umeclidinium/vilanterol] and ICS/LABA [fluticasone/vilanterol, budesonide/formoterol, salmeterol/fluticasone]) with each other or with placebo. A random-effects network meta-analysis combining direct and indirect evidence was conducted to examine the change from baseline in trough FEV1, transition dyspnea index, St George's Respiratory Questionnaire and frequency of adverse events at weeks 12 and 24. Results Inconsistency models were not statistically significant for all outcomes. LAMAs, LAMA/LABAs and ICS/LABAs led to a significantly greater improvement in trough FEV1 compared with placebo and SAMA monotherapy at weeks 12 and 24. All LAMA/LABAs, except aclidinium/formoterol, were statistically significantly better than LAMA monotherapy and ICS/LABAs in improving trough FEV1. Among the LAMAs, umeclidinium showed statistically significant improvement in trough FEV1 at week 12 compared to tiotropium and glycopyrronium, but the results were not clinically significant. LAMA/LABAs had the highest probabilities of being ranked the best agents in FEV1 improvement. Similar trends were observed for the transition dyspnea index and St George's Respiratory Questionnaire outcomes. There were no significant differences in the incidences of adverse events among all treatment options. Conclusion LAMA/LABA showed the greatest improvement in trough FEV1 at weeks 12 and 24 compared with the other inhaled drug classes, while SAMA showed the least improvement. There were no significant differences among the LAMAs and LAMA/LABAs within their respective classes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|