Cochrane on COPD: LAMA/LABA wins among options to reduce exacerbations

  • Oba Y & al.
  • Cochrane Database Syst Rev
  • 3 Dec 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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).

Limitations

  • Most studies excluded patients with cardiac comorbidities.

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