Comparison of three combined pharmacological approaches with tiotropium monotherapy in stable moderate to severe COPD: A systematic review
Por:
Rodrigo, GJ, Plaza, V, Castro-Rodriguez, JA
Publicada:
1 feb 2012
Resumen:
Background: Guidelines recommend the use of inhaled long-acting bronchodilators, inhaled corticosteroids (ICS) and their combinations for maintenance treatment of moderate to severe COPD. However, there are limited data supporting combination therapy.
Methods: This systematic review assessed the efficacy of three therapeutic approaches: tiotropium plus long-acting beta2-agonist (LABA) ("dual" therapy), LABA/ICS ("combined" therapy), and tiotropium plus LABAJICS ("triple" therapy), all compared with tiotropium monotherapy. Randomized controlled trials were identified after a search of different databases of published and unpublished trials.
Results: Twenty trials (6803 participants) were included. "Dual" therapy showed significant improvements in forced volume in the first second (FEV1), health-related quality of life (HRQoL), and dyspnea. However, it failed to reduce the risk of COPD exacerbations. Compared with tiotropium, "combined" therapy presented modest but significant effects on FEV1, HRQoL, and dyspnea. Again, there was no significant difference in exacerbations, but it was associated with a significant increase of serious adverse effects (SAE) (number need to treat for harm [NNTH] = 20; 95% CI: 11-119). Finally, "triple therapy" increased FEV1, improved HRQoL (both benefits exceeded minimal important differences) and decrease COPD exacerbations in anon-significant way. (Odds ratio [OR] = 0.57; 95% CI: 0.24 to 1.37, p = 0.21).
Conclusions: "Dual" and "triple" therapy seem like the most promising for patients with moderate to very severe COPD. However, data are still scarce and studies too short to generate a strong recommendation. Future studies should examine long-term efficacy and safety. (C) 2011 Elsevier Ltd. All rights reserved.
Filiaciones:
Rodrigo, GJ:
Hosp Cent Fuerzas Armadas, Dept Emergencia, Montevideo 11300, Uruguay
Plaza, V:
Univ Autonoma Barcelona, Serv Pneumol, Hosp Santa Creu & St Pau, Barcelona 08005, Spain
Castro-Rodriguez, JA:
Pontificia Univ Catolica Chile, Sch Med, Dept Family Med, Santiago, Chile
Pontificia Univ Catolica Chile, Sch Med, Dept Pediat, Santiago, Chile
|