• Pulm Pharmacol Ther · Dec 2019

    Meta Analysis Comparative Study

    Efficacy and cardiovascular safety profile of dual bronchodilation therapy in chronic obstructive pulmonary disease: A bidimensional comparative analysis across fixed-dose combinations.

    • Paola Rogliani, Maria Gabriella Matera, Beatrice Ludovica Ritondo, Ilaria De Guido, Ermanno Puxeddu, Mario Cazzola, and Luigino Calzetta.
    • Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy. Electronic address: paola.rogliani@uniroma2.it.
    • Pulm Pharmacol Ther. 2019 Dec 1; 59: 101841.

    AbstractDespite several long-acting β2-adrenoceptor agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combinations (FDCs) are currently approved for the treatment of chronic obstructive pulmonary disease (COPD), there are limited findings concerning the direct comparison across the different LABA/LAMA FDCs. The aim of this study was to compare the efficacy/safety profile of approved LABA/LAMA FDCs in COPD. A network meta-analysis was performed by linking the efficacy (forced expiratory volume in 1 s, St' George Respiratory Questionnaire, transitional dyspnea index) and safety (cardiovascular serious adverse events) outcomes resulting from randomized controlled trials that directly compared LABA/LAMA FDCs with placebo and/or each other. The Surface Under the Cumulative Ranking Curve Analysis (SUCRA) was performed for each single outcome (SUCRA: 1 = best, 0 = worst). The combined efficacy/safety profile was reported via the novel Improved Bidimensional SUCRA score (IBiS: the higher the value the better the treatment). Data obtained from 12,136 COPD patients (79.50% LABA/LAMA FDCs vs. placebo; 20.50% direct comparison between different LABA/LAMA FDCs) were extracted from 22 studies published between 2013 and 2019. The IBiS score showed the following rank of efficacy/safety profile: tiotropium/olodaterol 5/5 μg (area 66.83%) » glycopyrronium/indacaterol 15.6/27.5 μg (area 40.43%)  >  umeclidinium/vilanterol 62.5/25 μg (area 30.48%)  ≈  aclidinium/formoterol 400/12 μg (area 28.44%)  >  glycopyrronium/indacaterol 50/110 μg (area 19.95%)  >  glycopyrronium/formoterol 14.4/9.6 μg (area 11.50%). Each available LABA/LAMA FDC has a specific efficacy/safety profile that needs to be considered for personalized therapy in COPD. Head-to-head studies aimed to assess the impact of different LABA/LAMA FDCs on the risk of COPD exacerbation are needed to further improve the information provided by this quantitative synthesis.Copyright © 2019 Elsevier Ltd. All rights reserved.

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