Comparative safety and effectiveness of long-acting inhaled agents for treating chronic obstructive pulmonary disease: a systematic review and network meta-analysis

被引：43

作者：

Tricco, Andrea C. ^{[1
,2
]}

Strifler, Lisa ^{[1
]}

Veroniki, Areti-Angeliki ^{[1
]}

Yazdi, Fatemeh ^{[3
]}

Khan, Paul A. ^{[1
]}

Scott, Alistair ^{[1
]}

Ng, Carmen ^{[1
]}

Antony, Jesmin ^{[1
]}

Mrklas, Kelly ^{[1
,4
]}

D'Souza, Jennifer ^{[1
]}

Cardoso, Roberta ^{[1
]}

Straus, Sharon E. ^{[1
,5
]}

机构：

[1] St Michaels Hosp, Li Ka Shing Knowledge Inst, Knowledge Translat Program, Toronto, ON M5B 1W8, Canada

[2] Univ Toronto, Dalla Lana Sch Publ Hlth, Epidemiol Div, Toronto, ON, Canada

[3] Ottawa Hosp Gen Campus, Ctr Practice Changing Res Bldg, Ottawa Hosp Res Inst, Ottawa, ON, Canada

[4] Alberta Hlth Serv, Edmonton, AB, Canada

[5] Univ Toronto, Dept Geriatr Med, Toronto, ON, Canada

来源：

BMJ OPEN | 2015年 / 5卷 / 10期

基金：

加拿大健康研究院;

关键词：

Pulmonary Disease; Chronic Obstructive; Pulmonary Emphysema; Network Meta-analysis; Systematic Review; IMPROVES LUNG-FUNCTION; COMPARATIVE EFFICACY; COPD; TIOTROPIUM; INCONSISTENCY; HETEROGENEITY; AGONISTS; MODERATE;

D O I：

10.1136/bmjopen-2015-009183

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To compare the safety and effectiveness of long-acting -antagonists (LABA), long-acting antimuscarinic agents (LAMA) and inhaled corticosteroids (ICS) for managing chronic obstructive pulmonary disease (COPD). Setting Systematic review and network meta-analysis (NMA). Participants 208 randomised clinical trials (RCTs) including 134692 adults with COPD. Interventions LABA, LAMA and/or ICS, alone or in combination, versus each other or placebo. Primary and secondary outcomes The proportion of patients with moderate-to-severe exacerbations. The number of patients experiencing mortality, pneumonia, serious arrhythmia and cardiovascular-related mortality (CVM) were secondary outcomes. Results NMA was conducted including 20 RCTs for moderate-to-severe exacerbations for 26141 patients with an exacerbation in the past year. 32 treatments were effective versus placebo including: tiotropium, budesonide/formoterol, salmeterol, indacaterol, fluticasone/salmeterol, indacaterol/glycopyrronium, tiotropium/fluticasone/salmeterol and tiotropium/budesonide/formoterol. Tiotropium/budesonide/formoterol was most effective (99.2% probability of being the most effective according to the Surface Under the Cumulative RAnking (SUCRA) curve). NMA was conducted on mortality (88 RCTs, 97526 patients); fluticasone/salmeterol was more effective in reducing mortality than placebo, formoterol and fluticasone alone, and was the most effective (SUCRA=71%). NMA was conducted on CVM (37 RCTs, 55156 patients) and the following were safest: salmeterol versus each OF placebo, tiotropium and tiotropium (Soft Mist Inhaler (SMR)); fluticasone versus tiotropium (SMR); and salmeterol/fluticasone versus tiotropium and tiotropium (SMR). Triamcinolone acetonide was the most harmful (SUCRA=81%). NMA was conducted on pneumonia occurrence (54 RCTs, 61551 patients). 24 treatments were more harmful, including 2 that increased risk of pneumonia versus placebo; fluticasone and fluticasone/salmeterol. The most harmful agent was fluticasone/salmeterol (SUCRA=89%). NMA was conducted for arrhythmia; no statistically significant differences between agents were identified. Conclusions Many inhaled agents are available for COPD, some are safer and more effective than others. Our results can be used by patients and physicians to tailor administration of these agents. Protocol registration number PROSPERO # CRD42013006725.

引用

页数：13

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