Cochrane review confirms LABA/LAMA improves lung function and quality of life in COPD

  • Maqsood U & al.
  • Cochrane Database Syst Rev
  • 6 Mar 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Patients with stable chronic obstructive pulmonary disease (COPD) who received once-daily long-acting beta2-agonists and long-acting muscarinic antagonists (LABA/LAMA) showed a greater improvement in quality of life and lung function vs those who received placebo.

Why this matters

  • Future research should focus on relative net clinical benefit (i.e. considering both efficacy and safety) for different LABA/LAMA combinations.

Study design

  • Meta-analysis of 22 randomised controlled trials including 8641 patients with stable COPD who received LABA/LAMA combinations or placebo once-daily.
  • Funding: GSK.

Key results

  • Median study duration was 12 weeks (3-52 weeks).
  • Patients who received once-daily LABA/LAMA vs placebo showed no significant difference in all-cause mortality (pooled OR, 1.88; 95% CI, 0.81-4.36) or all-cause serious adverse events (pooled OR, 1.06; 95% CI, 0.88-1.28).
  • Once-daily LABA/LAMA was associated with lower
    • risk for acute exacerbations of COPD (pooled OR, 0.53; 95% CI, 0.36-0.78) and
    • adjusted St George’s Respiratory Questionnaire score (pooled mean difference [MD], −4.08; 95% CI, −4.80 to −3.36).
  • Once-daily LABA/LAMA showed significant improvement in
    • adjusted trough forced expiratory volume in one second (FEV1; pooled MD, 0.20 L; 95% CI, 0.19-0.21) and
    • adjusted peak FEV1 (pooled MD, 0.31 L; 95% CI, 0.29-0.32).
  • All-cause adverse events were similar with once-daily LABA/LAMA and placebo (pooled OR, 0.95; 95% CI, 0.86-1.04).
  • Evidence had generally moderate to high certainty except for all-cause mortality.

Limitations

  • Publication bias.
  • 6-minute walk test was not performed in included studies.

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