What are the most effective fixed-dose combinations for COPD?

  • Calzetta L & al.
  • Pulm Pharmacol Ther
  • 19 Oct 2019

  • International Clinical Digest
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Takeaway

  • For patients with moderate to severe COPD, a network meta-analysis finds that long-acting β2 agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combinations (FDCs) are more efficacious than inhaled corticosteroid (ICS)/LABA FDCs.

Why this matters

  • This is the first network meta-analysis comparing different FDCs.

Study design

  • Network meta-analysis of 16 randomised controlled trials (RCTs; n=17,734) after a search of MEDLINE, Scopus, Cochrane Library, and EMBASE, among other databases.
  • Primary outcomes: change from baseline in trough forced expiratory volume in 1 second (FEV1) and acute exacerbation of COPD (AECOPD).
  • Funding: None.

Key results

  • The upper quartile of the surface under the cumulative ranking curve (SUCRA) rankings to improve FEV1 were (in decreasing order):
    • LAMA/LABA: umeclidinium/vilanterol 62/25 μg once daily (OD),
    • LAMA/LABA: glycopyrronium/indacaterol 50/110 μg OD, and
    • LAMA/LABA: glycopyrronium/indacaterol 15.6/27.5 μg twice daily (BID).
  • The second and third quartile in the SUCRA rankings for FEV1 were:
    • LAMA/LABA: glycopyrrolate/formoterol 18/9.6 μg BID,
    • LAMA/LABA: tiotropium/olodaterol 5/5 μg OD,
    • ICS/LABA: fluticasone furoate/vilanterol 100/25 μg OD,
    • ICS/LABA: budesonide/formoterol 400/12 μg BID, and
    • ICS/LABA: beclomethasone dipropionate/formoterol 200/12 μg BID.
  • The top SUCRA rankings to reduce AECOPD were (in decreasing order):
    • LAMA/LABA: glycopyrronium/indacaterol 50/110 μg OD,
    • ICS/LABA: budesonide/formoterol 400/12 μg BID, and
    • ICS/LABA: beclomethasone dipropionate/formoterol 200/12 μg BID.

Limitations

  • Heterogeneity across studies.