- 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.
- Meta-analysis of 22 randomised controlled trials including 8641 patients with stable COPD who received LABA/LAMA combinations or placebo once-daily.
- Funding: GSK.
- 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.
- Publication bias.
- 6-minute walk test was not performed in included studies.