Efficacy of Budesonide/Glycopyrronium/Formoterol Fumarate Metered Dose Inhaler (BGF MDI) Versus Other Inhaled Corticosteroid/Long-Acting Muscarinic Antagonist/Long-Acting β
| Autor: | Gary T, Ferguson, Patrick, Darken, Shaila, Ballal, Mohd Kashif, Siddiqui, Barinder, Singh, Sumeet, Attri, Ulf, Holmgren, Enrico, de Nigris |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Long-acting β2-agonist Network Meta-Analysis Muscarinic Antagonists Muscarinic Agonists Exacerbations Pulmonary Disease Chronic Obstructive Fumarates Adrenal Cortex Hormones Inhaled corticosteroid Forced Expiratory Volume Formoterol Fumarate Administration Inhalation Humans Metered Dose Inhalers Budesonide Triple therapy Adrenergic beta-2 Receptor Agonists Aged Original Research Patient-reported outcomes Chronic obstructive pulmonary disease Bayes Theorem Middle Aged Glycopyrrolate Lung function Bronchodilator Agents Respiratory Function Tests Long-acting muscarinic antagonist Drug Combinations Dyspnea Treatment Outcome Female |
| Zdroj: | Advances in Therapy |
| ISSN: | 1865-8652 |
| Popis: | Introduction Triple inhaled corticosteroid/long-acting muscarinic antagonist/long-acting β2-agonist (ICS/LAMA/LABA) combination therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) who experience further exacerbations/symptoms on dual LAMA/LABA or ICS/LABA therapy. The relative efficacy of budesonide/glycopyrronium/formoterol fumarate metered dose inhaler 320/18/9.6 µg (BGF MDI) in COPD was compared with other ICS/LAMA/LABA fixed-dose and open combination therapies in a network meta-analysis (NMA). Methods A systematic literature review was conducted to identify randomized controlled trials of at least 10-week duration, including at least one fixed-dose or open combination triple therapy arm, in patients with moderate to very severe COPD. Studies were assessed for methodological quality and risk of bias. A three-level hierarchical Bayesian NMA model was used to determine the exacerbation rate per patient per year as well as the following outcomes at week 24: changes from baseline in pre-dose trough forced expiratory volume in 1 s (FEV1), post-dose peak FEV1, and St. George’s Respiratory Questionnaire (SGRQ) total score; proportion of SGRQ responders; and Transition Dyspnea Index focal score. Change from baseline in rescue medication use over weeks 12–24 was also analyzed. Meta-regression and sensitivity analyses were used to assess heterogeneity across studies. Results Eighteen studies (n = 29,232 patients) contributed to the NMA. ICS/LABA dual combinations were combined as a single treatment group to create a connected network. Across all outcomes, there were no statistically significant differences between BGF MDI and other triple ICS/LAMA/LABA fixed-dose (fluticasone furoate/umeclidinium/vilanterol and beclomethasone dipropionate/glycopyrronium/formoterol fumarate) and open combinations with data available within the network. Results from sensitivity analyses and meta-regression were consistent with the base-case scenario. Conclusion This NMA suggested that BGF MDI has comparable efficacy to other ICS/LAMA/LABA fixed-dose and open triple combination therapies in reducing exacerbations and improving lung function and symptoms in patients with moderate to very severe COPD. Further research is warranted as additional evidence regarding triple therapies, especially fixed-dose combinations, becomes available. Electronic supplementary material The online version of this article (10.1007/s12325-020-01311-3) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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