In patients with COPD, what effect does the combination of long-acting beta-agonist and inhaled coritcosteroid have on mortality?

Systematic reviews and meta-analyses

#1 Wilt TJ, et al. Management of stable chronic obstructive pulmonary disease: a systematic review for a clinical practice guideline. Ann Intern Med. 2007 Nov 6;147(9):639-53.

Objective: “To evaluate the effectiveness of COPD management strategies.”

Summary: A meta-analysis of 5 RCTs shows that the risk for all-cause mortality in patients using LABA/corticosteroids is slightly lower compared to those using a placebo.  A meta-analysis of 10 RCTs shows that the risk for all-cause mortality is no different for  patients using LABAs than for those taking a placebo.

Methods:
Searched Medline and Cochrane through March 2007 for English-language publications
Inclusion criteria:
Study type: Randomized, controlled trials (RCTs) and previous systematic reviews
Population: Adults with COPD
Interventions: Inhaled therapies, pulmonary rehabilitation, disease management, and supplemental oxygen

Studies independently reviewed, selected, and graded on quality be 2 independent reviewers with disagreements settled by consensus.

Data:
Figure 4 (p. 648) displays forest plot of relative risk for mortality (See bottom for section, “Combined LABA and corticosteroid therapy v. placebo)

#2 Rodrigo GJ, Nannini LJ, Rodríguez-Roisin R. Safety of Long-Acting β-Agonists in Stable COPD: A Systematic Review. Chest. 2008;133(5):1079-1087.

Objective: To assess the safety of long-acting β2-agonists (LABA) used in the management of COPD.

Summary: A meta-analysis of 13 RCTs shows that there is no statistically significant difference in the risk for all-cause mortality in patients using LABAs compared to those using a placebo.

Methods:
Searched Medline, EMBASE, CINAHL, and Cochrane Register of Clinical Trials for studies published through 2007. Paper includes reproducible search.
Inclusion criteria:
Population: Adult patients aged > 35 years with stable COPD satisfying American Thoracic Society/European Respiratory Society, or Global Initiative for Chronic Obstructive Lung Disease (GOLD) diagnostic criteria
Intervention: inhaled LABAs (delivered via metered-dose inhaler or dry powder) vs placebo or inhaled ipratropium bromide or inhaled tiotropium (with or without the additional use of SABAs); patients treated with LABAs as monotherapy or with a combination of LABAs and inhaled corticosteroids (ICS) were included in the analysis
Study design: randomized (parallel group or cross-over) controlled trials with follow-up of at least 4 weeks in duration
Primary outcomes: severe COPD exacerbations requiring withdrawal from the trial or hospitalization, all-cause mortality, and respiratory deaths (due to event such as COPD exacerbation, pneumonia or respiratory failure).
Other: all languages; only published studies (no abstracts)

Studies independently reviewed, selected, and graded on quality be 2 independent reviewers with disagreements settled by consensus.

Table 1 shows the characteristics of included studies

Results:
27 RCTs included in review, with 13 studies reporting on all-cause mortality.

Table 4 compares the relative risk for all-cause mortality for LABA and placebo, both with and without the use of inhaled corticosteroids.

Guidelines

#3 Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline from the American College of Physicians

Advertisements

About Amy

Clinical Informationist at EUH Branch Library
This entry was posted in EUH, Therapy. Bookmark the permalink.