RT Journal Article
SR Electronic
T1 Triple therapy versus single and dual long-acting bronchodilator therapy in chronic obstructive pulmonary disease: a systematic review and meta-analysis
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1801586
DO 10.1183/13993003.01586-2018
A1 Mario Cazzola
A1 Paola Rogliani
A1 Luigino Calzetta
A1 Maria Gabriella Matera
YR 2018
UL http://erj.ersjournals.com/content/early/2018/10/04/13993003.01586-2018.abstract
AB We performed a meta-analysis to compare the impact of triple combination therapy with inhaled corticosteroids (ICSs), long-acting β2-agonists (LABAs), and long-acting muscarinic receptor antagonists (LAMAs) versus LABA/LAMA combination or single long-acting bronchodilator therapy in chronic obstructive pulmonary disease. ICS/LABA/LAMA combination reduced the risk of exacerbation (relative risk: 0.70, 95%CI 0.53–0.94) and improved trough FEV1 (mean difference, mL: +37.94, 95%CI 18.83–53.89) versus LABA/LAMA combination. The protective effect of triple combination therapy versus LABA/LAMA combination against the risk of exacerbation was greater in patients with blood eosinophil counts ≥300 cells per µL (relative risk: 0.57, 95%CI 0.48–0.68). While ≈38 patients had to be treated for one year with ICS/LABA/LAMA combination to prevent one exacerbation compared to LABA/LAMA combination, the number needed to treat was ≈21 when compared to single long-acting bronchodilator therapy. The risk of pneumonia did not differ between ICS/LABA/LAMA combination and comparators; the number needed to harm was ≈195 and it decreased to ≈34 when considering the study that included fluticasone furoate in the triple combination. This meta-analysis suggests that patients on single long-acting bronchodilator therapy or LABA/LAMA combination, who still have exacerbations and have blood eosinophil count ≥300 cells per µL, could benefit from ICS/LABA/LAMA combination.FootnotesThis 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. 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. 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. 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.Conflict of interest: Dr. Matera reports personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, personal fees from AstraZeneca, personal fees from Chiesi Farmaceutici, personal fees from Almirall, personal fees from ABC Farmaceutici, personal fees from GlaxoSmithKline, outside the submitted work.