Benefits of adding fluticasone propionate/salmeterol to tiotropium in COPD: A meta-analysis

Liu, Yun; Shi, Hongyang; Sun, Xuegang; Zhang, Dexin; Zhang, Yuping; Yang, Kunzheng; Mi, Liehan; Li, Manxiang

doi:10.1016/j.ejim.2014.04.007

Cited by 16 publications

(16 citation statements)

References 21 publications

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“…Tiotropium was more effective than salmeterol [98] and indacaterol [45] in reducing exacerbation rates in COPD, irrespective of concomitant ICS use. A meta-analysis has shown that the combination of tiotropium and fluticasone/ salmeterol reduced exacerbations significantly more than by tiotropium alone [117]. The significance of LABA/LAMA fixed dose combinations on exacerbations is not still extensively studied.…”

Section: Effects On Exacerbations and Mortalitymentioning

confidence: 98%

“…Studies showed similar improvements in SGRQ score over placebo, after prolonged treatments with tiotropium via Respimat (À3.5 units) [ . Tiotropium did not significantly improve QoL more than fluticasone/salmeterol combination, while the association of tiotropium and fluticasone/salmeterol improved the mean SGRQ score significantly more than shown by tiotropium alone [117]. The mean improvement in SGRQ score of glycopyrronium/indacaterol combination over either tiotropium or glycopyrronium was significant [105,108]; also, it was more than that of fluticasone/salmeterol combination [76].…”

Section: Crossmentioning

confidence: 98%

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Long-acting muscarinic antagonists

Melani

2015

Expert Review of Clinical Pharmacology

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Chronic obstructive pulmonary disease (COPD) is a major cause of death and disability worldwide. Inhaled bronchodilators are the mainstay of COPD pharmacological treatment. Long-acting muscarinic antagonists (LAMAs) are a major class of inhaled bronchodilators. Some LAMA/device systems with different characteristics and dosing schedules are currently approved for maintenance therapy of COPD and a range of other products are being developed. They improve lung function and patient-reported outcomes and reduce acute bronchial exacerbations with good safety. LAMAs are used either alone or associated with long-acting β₂-agonists, eventually in fixed dose combinations. Long-acting β₂-agonist/LAMA combinations assure additional benefits over the individual components alone. The reader will obtain a view of the safety and efficacy of the different LAMA/device systems in COPD patients.

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Section: Effects On Exacerbations and Mortalitymentioning

confidence: 98%

Section: Crossmentioning

confidence: 98%

Long-acting muscarinic antagonists

Melani

2015

Expert Review of Clinical Pharmacology

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“…6 Several randomized controlled trials (RCTs) and metaanalyses have investigated the role of various inhaler combinations with regard to clinical outcomes of patients with poorly controlled disease and frequent exacerbations; however, the results are inconsistent. [7][8][9] Therefore, we conducted our meta-analysis aiming to evaluate the safety and efficacy of triple versus dual inhaler therapy in patients with frequent COPD exacerbations or poorly controlled symptoms.…”

Section: Introductionmentioning

confidence: 99%

Triple versus dual inhaler therapy in moderate‐to‐severe COPD: A systematic review and meta‐analysis of randomized controlled trials

Zayed

Barbarawi

Kheiri

et al. 2019

Clinical Respiratory J

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Introduction Treatment of chronic obstructive pulmonary disease (COPD) is evolving specially with triple inhaler therapy. Objectives To perform a meta‐analysis to ascertain the safety and efficacy of triple inhaler therapy consisting of an inhaled‐glucocorticoid (ICS), long‐acting muscarinic antagonist (LAMA) and long‐acting beta2‐agonist (LABA) when compared with dual therapy (ICS‐LABA or LAMA‐LABA). Methods We performed an electronic database search to include randomized controlled trials (RCTs) comparing between triple and dual inhalers. Pooled rate‐ratio (RR) or odds‐ratio (OR) for dichotomous data and weighted mean difference (MD) for continuous data were calculated with their corresponding 95% confidence interval (CI). Results Our study included 12 RCTs totaling 19,322 patients, mean age of 65 ± 8.2 years and 68.2% were male. Pooled analysis demonstrated a significant reduction in moderate‐to‐severe COPD exacerbations with triple therapy (RR 0.75; 95% CI 0.69‐0.83; P < 0.01). Additionally, triple therapy caused significant increase in trough FEV1 (MD 0.09 L; 95% CI 0.07‐0.12; P < 0.01), significant reduction in the mean St. George's Respiratory Questionnaire (SGRQ) score (MD −1.67; 95% CI −2.02‐ −1.31; P < 0.01), and more patients experienced ≥ 4 points reduction of SGRQ score (OR 1.27; 95% CI 1.19‐1.35; P < 0.01). Triple therapy was associated with an increased risk of pneumonia when compared to LABA/LAMA (OR 1.25; 95% 1.03‐1.97; P = 0.03) but there were no significant differences in other adverse events between triple and dual inhalers. Conclusions Among patients with moderate‐to‐severe COPD, triple inhaler therapy was associated with a reduction of moderate‐to‐severe COPD exacerbations, improved lung function and improved quality of life when compared to dual inhaler therapy but with an increased pneumonia risk.

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“…A more recent meta-analysis that has been performed to evaluate the efficacy and safety of adding fluticasone propionate/salmeterol to tiotropium in COPD patients, and has included six trials, has confirmed that the addition of fluticasone propionate/salmeterol to subjects with COPD treated with tiotropium significantly improves lung function, HRQoL, and COPD exacerbations without increasing the risk of adverse events [11].…”

Section: Evidences In Favor Of Triple Therapymentioning

confidence: 98%

Triple combinations in chronic obstructive pulmonary disease – is three better than two?

Cazzola

Matera

2014

Expert Opinion on Pharmacotherapy

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A growing body of evidence suggests that triple therapy with an antimuscarinic agent, a long-acting β2-agonist, and an inhaled corticosteroid is efficacious in patients with more severe chronic obstructive pulmonary disease (COPD), such as those with frequent exacerbations. Moreover, this therapy is often prescribed in real-life management of COPD, even in patients who are not suffering from severe COPD. All this makes triple therapy an attractive therapeutic approach. Therefore, a variety of triple combinations are currently under development. However, there are a number of issues that need to be addressed in order to optimize the use of triple therapy in COPD because data are still too scarce and studies too short to generate a strong recommendation.

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Benefits of adding fluticasone propionate/salmeterol to tiotropium in COPD: A meta-analysis

Cited by 16 publications

References 21 publications

Long-acting muscarinic antagonists

Long-acting muscarinic antagonists

Triple versus dual inhaler therapy in moderate‐to‐severe COPD: A systematic review and meta‐analysis of randomized controlled trials

Triple combinations in chronic obstructive pulmonary disease – is three better than two?

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