- Combinations of long-acting β-agonists (LABA) and long-acting muscarinic antagonists (LAMA) were most efficacious for prevention of COPD exacerbation in this network meta-analysis.
Why this matters
- Discussion is ongoing over whether LAMA, LABA, LAMA/LABA, or LABA/inhaled corticosteroid (ICS) inhalers are most effective in COPD.
- LABA/LAMA emerged as most efficacious, followed by LAMA.
- Network HRs with moderate-to-severe exacerbations in high-risk population, LABA/LAMA vs:
- LABA/ICS: 0.86 (95% credible interval [CrI], 0.76-0.99);
- LAMA: 0.87 (95% CrI, 0.78-0.99);
- LABA: 0.70 (95% CrI, 0.61-0.8).
- Network HRs, moderate-to-severe exacerbations, LAMA vs LABA:
- High-risk: 0.80 (95% CrI, 0.71-0.88);
- Low-risk: 0.87 (95% CrI, 0.78-0.97).
- Network HRs, severe exacerbations, high-risk population, LABA/LAMA vs:
- LABA/ICS: 0.78 (95% CrI, 0.64-0.93);
- LABA: 0.64 (95% CrI, 0.51-0.81).
- For pneumonia serious adverse events, odds were higher with LABA/ICS.
- For symptoms and QoL scores, combination therapies outperformed monotherapies.
- Systematic review and network meta-analysis of 99 randomized controlled trials lasting 12 weeks and assessing at least 2 active comparators (n=101,311).
- Participants had moderate-severe COPD; "high-risk" denotes those with ≥1 exacerbation in previous year.
- Outcome: moderate-severe exacerbation; severe exacerbation.
- Funding: National Institute for Health Research (UK).
- Most studies excluded patients with cardiac comorbidities.