Abstract
To date there are no network meta-analyses comparing the impact of as-needed treatments in asthma, including the single maintenance and reliever therapy (known as SMART or MART – for simplicity SMART will be used hereafter) and the use of inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination exclusively on an as-needed basis. Therefore, we performed a systematic review and network meta-analysis concerning the efficacy and safety of SMART and as-needed therapies in asthma. Data of 32 096 asthmatic patients were extracted from 21 studies, lasting from 6 to 12 months. In adult mild to moderate asthmatic patients low-dose (LD) SMART and as-needed LD ICS/LABA combination were significantly (relative effect <0.78, P<0.05) more effective than the other as-needed therapies in reducing the risk of exacerbation, and both were ranked as the first treatment option reaching the first quartile of the surface under the cumulative ranking curve analysis (SUCRA). In adult moderate to severe asthmatic patients LD to medium-dose (MD) SMART and high-dose (HD) ICS/LABA+as-needed short-acting β2-agonist were equally effective in reducing the risk of severe asthma exacerbation (P>0.05), although only LD to MD SMART was ranked as the first treatment option (first SUCRA quartile). Overall, these treatments were well tolerated and effective also on lung function and disease control. This study supports SMART and as-needed therapies as a suitable therapeutic option for asthma, by providing the most effective positioning of each specific treatment according to the disease severity.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Rogliani reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, personal fees from AstraZeneca, grants and personal fees from Chiesi Farmaceutici, grants and personal fees from Almirall, grants from Zambon, personal fees from Biofutura, personal fees from GlaxoSmithKline, personal fees from Menarini, personal fees from Mundipharma, outside the submitted work.
Conflict of interest: Dr. Ritondo has nothing to disclose.
Conflict of interest: Dr. Ora has nothing to disclose.
Conflict of interest: Dr. Cazzola reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, personal fees from AstraZeneca, personal fees from Chiesi Farmaceutici, grants and personal fees from Almirall, personal fees from ABC Farmaceutici, personal fees from Edmond Pharma, grants and personal fees from Zambon, personal fees from Verona Pharma, personal fees from Ockham Biotech, personal fees from Biofutura, personal fees from GlaxoSmithKline, personal fees from Menarini, personal fees from Lallemand, personal fees from Mundipharma, personal fees from Pfizer, outside the submitted work.
Conflict of interest: Dr. Calzetta reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, non-financial support from AstraZeneca, grants from Chiesi Farmaceutici, grants from Almirall, personal fees from ABC Farmaceutici, personal fees from Edmond Pharma, grants and personal fees from Zambon, personal fees from Verona Pharma, personal fees from Ockham Biotech, outside the submitted work.
This is a PDF-only article. Please click on the PDF link above to read it.
- Received March 10, 2020.
- Accepted May 7, 2020.
- Copyright ©ERS 2020