Abstract | BACKGROUND: METHODS: Several databases and manufacturer’s websites were searched for relevant clinical trials. Randomized, controlled trials, of at least 12 weeks duration, comparing a LAMA with placebo or another LAMA were included. Moderate-to-severe and severe exacerbations were chosen as the outcome assessment criteria. The data were pooled using network meta-analysis. RESULTS: A total of 27 studies with 48,140 subjects were included. All LAMAs reduced moderate-to-severe exacerbations compared with placebo. However, there were no statistically significant differences in preventing moderate-to-severe or severe exacerbations among LABAs. In a subgroup analysis restricting studies to those that had a minimum of 6 months of treatment, glycopyrronium was associated with the least-effective strategy and aclidinium was associated with the greatest probability of being the best therapy in preventing severe exacerbations. Our meta-regression analysis suggested that the prevention of COPD exacerbations were less effective in studies which allowed concomitant use of a long-acting beta agonist (LABA). CONCLUSION: All LAMAs were equally effective in preventing moderate-to-severe exacerbations. Aclidinium was associated with the lowest risk for severe exacerbations when treatment duration was 6 months or longer. The concomitant use of LABA may not enhance the efficacy of LAMAs in preventing COPD exacerbations. More studies are needed to further examine above findings.
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Authors | Yuji Oba, Nazir A Lone |
Journal | Therapeutic advances in respiratory disease
(Ther Adv Respir Dis)
Vol. 9
Issue 1
Pg. 3-15
(Feb 2015)
ISSN: 1753-4666 [Electronic] England |
PMID | 25586493
(Publication Type: Journal Article, Meta-Analysis, Review)
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Chemical References |
- Bronchodilator Agents
- Muscarinic Antagonists
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Topics |
- Bronchodilator Agents
(adverse effects, therapeutic use)
- Disease Progression
- Humans
- Lung
(drug effects, physiopathology)
- Muscarinic Antagonists
(adverse effects, therapeutic use)
- Pulmonary Disease, Chronic Obstructive
(diagnosis, drug therapy, physiopathology)
- Randomized Controlled Trials as Topic
- Severity of Illness Index
- Time Factors
- Treatment Outcome
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