Combined corticosteroid and long-acting beta<sub>2</sub>-agonist in one inhaler versus long-acting beta<sub>2</sub>-agonists for chronic obstructive pulmonary disease

Nannini, Luís J.; Lasserson, Toby J; Poole, Phillippa

doi:10.1002/14651858.cd006829.pub2

Cited by 174 publications

(89 citation statements)

References 60 publications

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“…However, ICS do improve lung function and reduce exacerbations, both alone and in combination with a long-acting b-agonist [36,37]. It is possible that the reduction in exacerbations in itself could result in a reduced risk of CVD events.…”

Section: Discussionmentioning

confidence: 99%

The Study to Understand Mortality and Morbidity in COPD (SUMMIT) study protocol

et al. 2012

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Chronic obstructive pulmonary disease (COPD) often coexists with other chronic diseases and comorbidities that can markedly influence patients' health status and prognosis. This is particularly true for cardiovascular disease (CVD). However, there have been no trials assessing the effect of COPD medications on CVD in patients with both diseases.The ''Study to Understand Mortality and Morbidity in COPD'' (SUMMIT) aims at determining the impact of fluticasone furoate/vilanterol combination and the individual components on the survival of patients with moderate COPD and either a history of CVD or at increased risk for CVD.SUMMIT is a multicentre, randomised, double-blind, parallel-group, placebo-controlled trial of 16 000 patients with moderate COPD randomly assigned to once daily treatment with fluticasone furoate/vilanterol (100/25 mg), fluticasone furoate (100 mg), vilanterol (25 mg) or matched placebo; mortality is the primary end-point. The study is an event-driven trial powered by the comparison of furoate/vilanterol versus placebo. Secondary end-points are decline in forced expiratory volume in 1 s and effect on a composite cardiovascular end-point. This article describes the design of the SUMMIT study.

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Section: Discussionmentioning

confidence: 99%

The Study to Understand Mortality and Morbidity in COPD (SUMMIT) study protocol

et al. 2012

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“…A recent meta-analysis of studies comparing LABA/ICS to LABA alone questioned the superiority of the combination in reducing exacerbations, noting that no reduction in COPD hospitalisations was seen and voiced concerns as to the analysis and the availability of data [44]. Specifically, attrition rates were high and the analysis of exacerbations remains problematic [20].…”

Section: Rcts Of Laba/ics Combinations and Their Methodological Limitmentioning

confidence: 99%

Inhaled corticosteroids in COPD: the clinical evidence

2014

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In this article, we focus on the scientific evidence from randomised trials supporting treatment with inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), including treatment with combinations of long-acting β-agonist (LABA) bronchodilators and ICS. Our emphasis is on the methodological strengths and limitations that guide the conclusions that may be drawn.The evidence of benefit of ICS and, therefore, of the LABA/ICS combinations in COPD is limited by major methodological problems. From the data reviewed herein, we conclude that there is no survival benefit independent of the effect of long-acting bronchodilation and no effect on FEV1 decline, and that the possible benefit on reducing severe exacerbations is unclear. Our interpretation of the data is that there are substantial adverse effects from the use of ICS in patients with COPD, most notably severe pneumonia resulting in excess deaths.Currently, the most reliable predictor of response to ICS in COPD is the presence of eosinophilic inflammation in the sputum. There is an urgent need for better markers of benefit and risk that can be tested in randomised trials for use in routine specialist practice. Given the overall safety and effectiveness of long-acting bronchodilators in subjects without an asthma component to their COPD, we believe use of such agents without an associated ICS should be favoured. @ERSpublicationsThe benefits of ICS in COPD are limited. Better tools are needed to identify which patients might benefit.

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“…For example, in the SPARK study (indacaterol and glycopyrronium), the combination only reduced exacerbations by a further 12% over monotherapy [52]. LABA/ICS have been demonstrated to improve lung function and HRQoL and to reduce exacerbations by ∼25% in COPD patients [7]. Whilst most COPD trials have not focused on frequent exacerbators, international guidelines recognise the impact of certain drug classes on exacerbation frequency, emphasising the role of LABA/ICS [53].…”

Section: Subgroups With Implications For Treatmentmentioning

confidence: 99%

Clinically relevant subgroups in COPD and asthma

Turner

Tamási

Schleich³

et al. 2015

Eur Respir Rev

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As knowledge of airways disease has grown, it has become apparent that neither chronic obstructive pulmonary disease (COPD) nor asthma is a simple, easily defined disease. In the past, treatment options for both diseases were limited; thus, there was less need to define subgroups. As treatment options have grown, so has our need to predict who will respond to new drugs. To date, identifying subgroups has been largely reported by detailed clinical characterisation or differences in pathobiology. These subgroups are commonly called "phenotypes"; however, the problem of defining what constitutes a phenotype, whether this should include comorbid diseases and how to handle changes over time has led to the term being used loosely.In this review, we describe subgroups of COPD and asthma patients whose clinical characteristics we believe have therapeutic or major prognostic implications specific to the lung, and whether these subgroups are constant over time. Finally, we will discuss whether the subgroups we describe are common to both asthma and COPD, and give some examples of how treatment might be tailored in patients where the subgroup is clear, but the label of asthma or COPD is not. @ERSpublications Summary of subgroups of airways disease that can be found in COPD and asthma, and their management

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Combined corticosteroid and long-acting beta₂-agonist in one inhaler versus long-acting beta₂-agonists for chronic obstructive pulmonary disease

Abstract: Background-Both inhaled steroids (ICS) and long-acting beta 2 -agonists (LABA) are used in the management of chronic obstructive pulmonary disease (COPD). This updated review compared compound LABA plus ICS therapy (LABA/ICS) with the LABA component drug given alone.

Cited by 174 publications

References 60 publications

The Study to Understand Mortality and Morbidity in COPD (SUMMIT) study protocol

The Study to Understand Mortality and Morbidity in COPD (SUMMIT) study protocol

Inhaled corticosteroids in COPD: the clinical evidence

Clinically relevant subgroups in COPD and asthma

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Combined corticosteroid and long-acting beta2-agonist in one inhaler versus long-acting beta2-agonists for chronic obstructive pulmonary disease

Abstract: Background-Both inhaled steroids (ICS) and long-acting beta 2 -agonists (LABA) are used in the management of chronic obstructive pulmonary disease (COPD). This updated review compared compound LABA plus ICS therapy (LABA/ICS) with the LABA component drug given alone.

Cited by 174 publications

References 60 publications

The Study to Understand Mortality and Morbidity in COPD (SUMMIT) study protocol

The Study to Understand Mortality and Morbidity in COPD (SUMMIT) study protocol

Inhaled corticosteroids in COPD: the clinical evidence

Clinically relevant subgroups in COPD and asthma

Contact Info

Product

Resources

About

Combined corticosteroid and long-acting beta₂-agonist in one inhaler versus long-acting beta₂-agonists for chronic obstructive pulmonary disease