长效支气管扩张剂治疗 COPD 的疗效比较：一项网状荟萃分析。

BACKGROUND

Clinicians are faced with an increasingly difficult choice regarding the optimal bronchodilator for patients with chronic obstructive pulmonary disease (COPD) given the number of new treatments. The objective of this study is to evaluate the comparative efficacy of indacaterol 75/150/300 μg once daily (OD), glycopyrronium bromide 50 μg OD, tiotropium bromide 18 μg/5 μg OD, salmeterol 50 μg twice daily (BID), formoterol 12 μg BID, and placebo for moderate to severe COPD.

METHODS

Forty randomized controlled trials were combined in a Bayesian network meta-analysis. Outcomes of interest were trough and post-dose forced expiratory volume in 1 second (FEV1), St. George's Respiratory Questionnaire (SGRQ) score and responders (≥4 points), and Transition Dyspnea Index (TDI) score and responders (≥1 point) at 6 months.

RESULTS

Indacaterol was associated with a higher trough FEV1 than other active treatments (difference for indacaterol 150 μg and 300 μg versus placebo: 152 mL (95% credible interval (CrI): 126, 179); 160 mL (95% CrI: 133, 187)) and the greatest improvement in SGRQ score (difference for indacaterol 150 μg and 300 μg versus placebo: -3.9 (95% CrI -5.2, -2.6); -3.6 (95% CrI -4.8, -2.3)). Glycopyrronium and tiotropium 18 μg resulted in the next best estimates for both outcomes with minor differences (difference for glycopyrronium versus tiotropium for trough FEV1 and SGRQ: 18 mL (95% CrI: -16, 51); -0.55 (95% CrI: -2.04, 0.92).

CONCLUSION

In terms of trough FEV1 and SGRQ score indacaterol, glycopyrronium, and tiotropium are expected to be the most effective bronchodilators.

背景

由于新的治疗方法数量众多，临床医生在为慢性阻塞性肺疾病（COPD）患者选择最佳支气管扩张剂时面临着越来越困难的选择。本研究的目的是评估每天一次（OD）的茚达特罗 75/150/300μg、格隆溴铵 50μg、噻托溴铵 18μg/5μg、沙美特罗 50μg 每日两次（BID）、福莫特罗 12μg BID 和安慰剂在中重度 COPD 中的比较疗效。

方法

40 项随机对照试验合并在贝叶斯网络荟萃分析中。感兴趣的结局是谷值和给药后 1 秒用力呼气量（FEV1）、圣乔治呼吸问卷（SGRQ）评分和应答者（≥4 分）、以及过渡呼吸困难指数（TDI）评分和应答者（≥1 分）在 6 个月时。

结果

与其他活性治疗相比，茚达特罗与更高的谷值 FEV1 相关（与安慰剂相比，茚达特罗 150μg 和 300μg 的差异：152mL（95%可信区间（CrI）：126，179）；160mL（95%CrI：133，187）），并且 SGRQ 评分的改善最大（与安慰剂相比，茚达特罗 150μg 和 300μg 的差异：-3.9（95%CrI：-5.2，-2.6）；-3.6（95%CrI：-4.8，-2.3））。与噻托溴铵相比，格隆溴铵 18μg 对这两个结局的估计结果次之，差异较小（与安慰剂相比，格隆溴铵和噻托溴铵在谷值 FEV1 和 SGRQ 方面的差异：18mL（95%CrI：-16，51）；-0.55（95%CrI：-2.04，0.92））。