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- Title
LABA/LAMA versus LABA/ICS fixed-dose combinations in the prevention of COPD exacerbations: a modeling analysis of literature aggregate data.
- Authors
Gong, Yiwen; Sui, Zichao; Lv, Yinghua; Zheng, Qingshan; Li, Lujin
- Abstract
Objectives: This study aimed to quantitatively compare the efficacy and safety of long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) and LABA/inhaled corticosteroid (ICS) fixed-dose combinations (FDCs) in preventing moderate or severe chronic obstructive pulmonary disease (COPD) exacerbations. Methods: A literature search was performed using public databases. The time course characteristics of the probability of a moderate or severe exacerbation in stable COPD patients treated with LABA/LAMA and LABA/ICS FDCs were described by the parametric survival function. A random-effects model in a single-arm meta-analysis was used to analyze the incidence of serious adverse events (SAEs) and pneumonia. Results: Twenty studies including 23,955 participants were included. The proportion of participants with a history of COPD exacerbation (%) in the previous year and the postbronchodilator forced expiratory volume in the first second (FEV1) (%predicted) were important factors affecting drug efficacy. After adjusting the above factors to median levels of 100% and 45.5%, respectively, the moderate or severe exacerbation rates at 52 weeks for olodaterol/tiotropium, formoterol/budesonide, indacaterol/glycopyrronium, formoterol/glycopyrronium, vilanterol/fluticasone, salmeterol/fluticasone, and vilanterol/umeclidinium were 38.3%, 41.0%, 42.6%, 47.0%, 47.5%, 47.9%, and 53.0%, respectively. In terms of safety, significant differences were observed among drugs containing different LABA/LAMA FDCs. Conclusions: This study showed that not all LABA/LAMA FDCs were superior to LABA/ICS FDCs in safety and in preventing moderate or severe exacerbations in patients with stable COPD, providing important quantitative information for COPD-related guidelines.
- Subjects
RISK factors of pneumonia; ADRENERGIC beta agonists; DRUG efficacy; INDACATEROL; ADRENOCORTICAL hormones; COMBINATION drug therapy; META-analysis; SALMETEROL; SYSTEMATIC reviews; OBSTRUCTIVE lung diseases; DESCRIPTIVE statistics; FORCED expiratory volume; FLUTICASONE; RESEARCH funding; ADVERSE health care events; MUSCARINIC antagonists; DISEASE exacerbation; PATIENT safety; BUDESONIDE; EVALUATION
- Publication
European Journal of Clinical Pharmacology, 2023, Vol 79, Issue 10, p1321
- ISSN
0031-6970
- Publication type
Article
- DOI
10.1007/s00228-023-03543-y