Chest
Original Research: COPDA Systematic Review With Meta-Analysis of Dual Bronchodilation With LAMA/LABA for the Treatment of Stable COPD
Section snippets
Searching Strategy
This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement (Fig 1).9
We performed a comprehensive literature search for RCTs lasting at least 3 months and concerning the influence of treatment with LABAs and LAMAs administered in combination in patients suffering from COPD diagnosed by pulmonary function testing.1, 10
The terms “chronic obstructive pulmonary disease” and “COPD” were included for the disease; the
Study Characteristics
Results obtained from 23,168 patients with COPD (combinations, n = 10,328; monocomponents, n = 12,840) were selected from 14 published papers and one abstract presented at the European Respiratory Society Congress (Amsterdam, 2015) that reported 22 RCTs. Two studies (two RCTs) used aclidinium and formoterol,27, 28 three studies (six RCTs) used tiotropium and olodaterol,29, 30, 31 four studies (five RCTs) used glycopyrronium and indacaterol,32, 33, 34, 35 five studies (seven RCTs) used
Discussion
The main finding of this meta-analysis is that, regardless of the LAMA/LABA combination examined, dual bronchodilation was always more effective than the LAMA or LABA alone in terms of the improvement in trough FEV1. All LAMA/LABA combinations also improved TDI and SGRQ scores compared with monocomponents, although the impact of the different LAMA/LABA combinations on patient-reported outcomes has not always been examined, or at least described, in a complete manner in the available reports,
Acknowledgments
Author contributions: M. C. contributed to study conception and design, drafting the submitted article and revising it critically for important intellectual content, and providing final approval of the version to be published. L. C. contributed to acquisition, analysis, and interpretation of data; drafting the submitted article and revising it critically for important intellectual content; and providing final approval of the version to be published. P. R. and M. G. M. contributed to acquisition
References (48)
- et al.
Pharmacological characterization of the interaction between aclidinium bromide and formoterol fumarate on human isolated bronchi
Eur J Pharmacol
(2014) - et al.
Searching for the synergistic effect between aclidinium and formoterol: from bench to bedside
Respir Med
(2015) - et al.
Pharmacological interaction between LABAs and LAMAs in the airways: optimizing synergy
Eur J Pharmacol
(2015) - et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials
(1996) - et al.
Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature
J Clin Epidemiol
(2000) - et al.
Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis
J Clin Epidemiol
(2001) - et al.
Tiotropium + olodaterol shows clinically meaningful improvements in quality of life
Respir Med
(2015) - et al.
Analysis of chronic obstructive pulmonary disease exacerbations with the dual bronchodilator QVA149 compared with glycopyrronium and tiotropium (SPARK): a randomised, double-blind, parallel-group study
Lancet Respir Med
(2013) - et al.
Once-daily umeclidinium/vilanterol 125/25 mcg in COPD: a randomized, controlled study
Chest
(2014) - et al.
Efficacy and safety of umeclidinium plus vilanterol versus tiotropium, vilanterol, or umeclidinium monotherapies over 24 weeks in patients with chronic obstructive pulmonary disease: results from two multicentre, blinded, randomised controlled trials
Lancet Respir Med
(2014)
Efficacy and safety of once-daily umeclidinium/vilanterol 62.5/25 mcg in COPD
Respir Med
A call for action: comparative effectiveness research in asthma
J Allergy Clin Immunol
Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society
Ann Intern Med
Beyond lung function in COPD management: effectiveness of LABA/LAMA combination therapy on patient-centred outcomes
Prim Care Respir J
Translational study searching for synergy between glycopyrronium and indacaterol
COPD
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement
Open Med
Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper
Eur Respir J
Retrieving clinical evidence: a comparison of PubMed and Google Scholar for quick clinical searches
J Med Internet Res
Long-acting inhaled therapy (beta-agonists, anticholinergics and steroids) for COPD: a network meta-analysis
Cochrane Database Syst Rev
Role of combined indacaterol and glycopyrronium bromide (QVA149) for the treatment of COPD in Japan
Int J Chron Obstruct Pulmon Dis
Differential pharmacology and clinical utility of emerging combination treatments in the management of COPD—role of umeclidinium/vilanterol
Int J Chron Obstruct Pulmo. Dis
Once-daily long-acting beta-agonists for chronic obstructive pulmonary disease: an indirect comparison of olodaterol and indacaterol
Int J Chron Obstruct Pulmon Dis
Cited by (0)
FUNDING/SUPPORT: The Department of Systems Medicine of the University of Rome Tor Vergata was funded by Almirall, Novartis, and Zambon, and is funded by Boehringer Ingelheim to conduct research in the respiratory field.