Comparative efficacy of inhaled medications (ICS/LABA, LAMA, LAMA/LABA and SAMA) for COPD: a systematic review and network meta-analysis

Aziz, Mohamed Ismail Abdul; Tan, Ling; Wu, David Bin-Chia; Pearce, Fiona; Chua, Gerald Seng Wee; Lin, Liang; Tan, Ping-Tee

doi:10.2147/copd.s173472

Cited by 39 publications

(16 citation statements)

References 91 publications

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“…A recent meta-analysis and systematic review found that the use of fixed-dose LAMA/LABA inhalers resulted in the greatest FEV 1 improvement at weeks 12 and 24 in COPD patients compared to the use of a short-acting MRA (SAMA) alone, LAMA alone or fixed-dose ICS/LABA 59. Similarly, the current review of the efficacy of inhaled UMEC/VI confirms its effectiveness and safety in COPD patients.…”

Section: Fixed-dose Combination Inhaler Of Umec/vi/fluticasone Furoatesupporting

confidence: 62%

<p>Evidence-based review of data on the combination inhaler umeclidinium/vilanterol in patients with COPD</p>

Albertson¹,

Bowman²,

Harper³

et al. 2019

COPD

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The use of inhaled, fixed-dose, long-acting muscarinic antagonists (LAMA) combined with long-acting, beta 2 -adrenergic receptor agonists (LABA) has become a mainstay in the maintenance treatment of chronic obstructive pulmonary disease (COPD). One of the fixed-dose LAMA/LABA combinations is the dry powder inhaler (DPI) of umeclidinium bromide (UMEC) and vilanterol trifenatate (VI) (62.5 µg/25 µg) approved for once-a-day maintenance treatment of COPD. This paper reviews the use of fixed-dose combination LAMA/LABA agents focusing on the UMEC/VI DPI inhaler in the maintenance treatment of COPD. The fixed-dose combination LAMA/LABA inhaler offers a step beyond a single inhaled maintenance agent but is still a single device for the COPD patient having frequent COPD exacerbations and persistent symptoms not well controlled on one agent. Currently available clinical trials suggest that the once-a-day DPI of UMEC/VI is well-tolerated, safe and non-inferior or better than other currently available inhaled fixed-dose LAMA/LABA combinations for COPD.

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Section: Fixed-dose Combination Inhaler Of Umec/vi/fluticasone Furoatesupporting

confidence: 62%

<p>Evidence-based review of data on the combination inhaler umeclidinium/vilanterol in patients with COPD</p>

Albertson¹,

Bowman²,

Harper³

et al. 2019

COPD

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“…Although previous pairwise meta-analyses found that ICS/LAMA/LABA had benefits in reducing lung function decline and preventing acute exacerbations compared with LAMA/LABA [27] and ICS/LABA [28], mortality was not evaluated. The significant benefit of reducing all-cause mortality in the inhaled drug classes was not elucidated in recent NMAs [5][6][7]. Our study including all available 219 RCTs found that ICS/LAMA/LABA reduced all-cause mortality compared with the other inhaled therapies, except for ICS/LABA.…”

Section: Discussionmentioning

confidence: 62%

“…A recent pairwise meta-analysis showed that ICS/ LAMA/LABA was associated with a lower risk of exacerbations but failed to reveal the efficacy in reducing mortality in any drug class [4]. Two additional network meta-analyses (NMAs) have been performed, but these studies included neither recent important large randomized controlled trials (RCTs) [5] nor RCTs investigating ICS/LAMA/LABA [6,7]. Safety issues, including pneumonia with ICS [8][9][10] and cardiovascular events with LAMA and LABA [11,12], also cannot be ignored.…”

Section: Introductionmentioning

confidence: 99%

Comparisons of Exacerbations and Mortality Among Regular Inhaled Therapies for Patients with Stable Chronic Obstructive Pulmonary Disease: Systematic Review and Bayesian Network Meta-Analysis

Lee

Park

et al. 2018

SSRN Journal

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Background Although exacerbation and mortality are the most important clinical outcomes of stable chronic obstructive pulmonary disease (COPD), the drug classes that are the most efficacious in reducing exacerbation and mortality among all possible inhaled drugs have not been determined. Methods and findings We performed a systematic review (SR) and Bayesian network meta-analysis (NMA). We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the European Union Clinical Trials Register, and the official websites of pharmaceutical companies (from inception to July 9, 2019). The eligibility criteria were as follows: (1) parallel-design randomized controlled trials (RCTs); (2) adults with stable COPD; (3) comparisons among long-acting muscarinic antagonists (LAMAs), long-acting beta-agonists (LABAs), inhaled corticosteroids (ICSs), combined treatment (ICS/LAMA/ LABA, LAMA/LABA, or ICS/LABA), or a placebo; and (4) study duration � 12 weeks. This study was prospectively registered in International Prospective Register of Systematic Reviews (PROSPERO; CRD42017069087). In total, 219 trials involving 228,710 patients were included. Compared with placebo, all drug classes significantly reduced the total exacerbations and moderate to severe exacerbations. ICS/LAMA/LABA was the most efficacious treatment for reducing the exacerbation risk (odds ratio [OR] = 0.57; 95% credible interval [CrI] 0.50-0.64; posterior probability of OR > 1 [P(OR > 1)] < 0.001). In addition, in contrast to the other drug classes, ICS/LAMA/LABA and ICS/LABA were associated with a significantly higher probability of reducing mortality than placebo (OR = 0.74, 95% CrI 0.

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“…8 Additionally, a number of systematic reviews and meta-analyses pertaining to inhaled therapies for COPD have been published recently; however, these did not review observational research. [9][10][11] In this systematic review and network meta-analysis (NMA), we investigate which inhaled therapy strategy is most effective at reducing exacerbation risk, improving lung function, improving health-related quality of life and minimising adverse events in patients with COPD. Here we examine the risk benefit of inhaled therapies, with particular emphasis on triple therapy (LAMA+LABA+ICS) versus LAMA+LABA.…”

Section: Open Accessmentioning

confidence: 99%

Inhaled therapies for chronic obstructive pulmonary disease: a systematic review and meta-analysis

et al. 2020

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ObjectivesTo integrate evidence from randomised controlled trials (RCTs) and observational studies on the efficacy of inhaled treatments for chronic obstructive pulmonary disease using network meta-analyses.MethodsSystematic searches MEDLINE and Embase based on predetermined criteria. Network meta-analyses of RCTs investigated efficacy on exacerbations (long-term: ≥20 weeks of treatment; short-term: <20 weeks), lung function (≥12 weeks), health-related quality of life, mortality and adverse events. Qualitative comparisons of efficacies between RCTs and observational studies.Results212 RCTs and 19 observational studies were included. Compared with combined long-acting beta-adrenoceptor agonists and long-acting muscarinic antagonists (LABA+LAMA), triple therapy (LABA+LAMA+inhaled corticosteroid) was significantly more effective at reducing exacerbations (long-term 0.85 (95% CI: 0.78 to 0.94; short-term 0.67 (95% CI: 0.49 to 0.92)) and mortality (0.72 (95% CI: 0.59 to 0.89)) but was also associated with increased pneumonia (1.35 (95% CI: 1.10 to 1.67)). No differences in lung function (0.02 (95% CI: −0.10 to 0.14)), health-related quality of life (−1.12 (95% CI: −3.83 to 1.59)) or other adverse events (1.02 (95% CI: 0.96 to 1.08)) were found. Most of the observational evidence trended in the same direction as pooled RCT data.ConclusionFurther evidence, especially pragmatic trials, are needed to fully understand the characteristics of patient subgroups who may benefit from triple therapy and for those whom the extra risk of adverse events, such as pneumonia, may outweigh any benefits.PROSPERO registration numberCRD42018088013.

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Comparative efficacy of inhaled medications (ICS/LABA, LAMA, LAMA/LABA and SAMA) for COPD: a systematic review and network meta-analysis

Cited by 39 publications

References 91 publications

<p>Evidence-based review of data on the combination inhaler umeclidinium/vilanterol in patients with COPD</p>

<p>Evidence-based review of data on the combination inhaler umeclidinium/vilanterol in patients with COPD</p>

Comparisons of Exacerbations and Mortality Among Regular Inhaled Therapies for Patients with Stable Chronic Obstructive Pulmonary Disease: Systematic Review and Bayesian Network Meta-Analysis

Inhaled therapies for chronic obstructive pulmonary disease: a systematic review and meta-analysis

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