Department of General Practice, Academic Medical Center, University of Amsterdam, PO box 22700, 1105 DE, Amsterdam, Netherlands
Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Berne, Switzerland Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland Swiss Paraplegic Research, Nottwil, Switzerland.
BMJ. 2014 May 13;348:g3009. doi: 10.1136/bmj.g3009.
To determine the comparative effectiveness and safety of current maintenance strategies in preventing exacerbations of asthma.
Systematic review and network meta-analysis using Bayesian statistics.
Cochrane systematic reviews on chronic asthma, complemented by an updated search when appropriate. ELIGIBILITY CRITERIA TRIALS OF Adults with asthma randomised to maintenance treatments of at least 24 weeks duration and that reported on asthma exacerbations in full text. Low dose inhaled corticosteroid treatment was the comparator strategy. The primary effectiveness outcome was the rate of severe exacerbations. The secondary outcome was the composite of moderate or severe exacerbations. The rate of withdrawal was analysed as a safety outcome.
64 trials with 59,622 patient years of follow-up comparing 15 strategies and placebo were included. For prevention of severe exacerbations, combined inhaled corticosteroids and long acting β agonists as maintenance and reliever treatment and combined inhaled corticosteroids and long acting β agonists in a fixed daily dose performed equally well and were ranked first for effectiveness. The rate ratios compared with low dose inhaled corticosteroids were 0.44 (95% credible interval 0.29 to 0.66) and 0.51 (0.35 to 0.77), respectively. Other combined strategies were not superior to inhaled corticosteroids and all single drug treatments were inferior to single low dose inhaled corticosteroids. Safety was best for conventional best (guideline based) practice and combined maintenance and reliever therapy.
Strategies with combined inhaled corticosteroids and long acting β agonists are most effective and safe in preventing severe exacerbations of asthma, although some heterogeneity was observed in this network meta-analysis of full text reports.
确定当前维持治疗策略在预防哮喘恶化方面的比较效果和安全性。
系统评价和贝叶斯网络荟萃分析。
慢性哮喘的 Cochrane 系统评价，在适当情况下补充最新搜索。
随机分配至至少 24 周维持治疗且全文报告哮喘恶化的成年哮喘患者的试验。低剂量吸入皮质类固醇治疗为比较策略。主要有效性结局为严重恶化的发生率。次要结局为中重度恶化的综合发生率。退出率作为安全性结局进行分析。
纳入了 64 项试验，共 59622 患者年的随访结果，比较了 15 种策略和安慰剂。对于预防严重恶化，联合吸入皮质类固醇和长效β激动剂作为维持和缓解治疗以及固定日剂量联合吸入皮质类固醇和长效β激动剂的效果同样好，且排名第一。与低剂量吸入皮质类固醇相比，其率比值分别为 0.44（95%可信区间 0.29 至 0.66）和 0.51（0.35 至 0.77）。其他联合策略并不优于皮质类固醇，所有单一药物治疗均劣于单一低剂量吸入皮质类固醇。常规最佳（基于指南）实践和联合维持和缓解治疗的安全性最佳。
在预防哮喘严重恶化方面，联合吸入皮质类固醇和长效β激动剂的策略最为有效和安全，尽管对全文报告的网络荟萃分析存在一定异质性。
