Calzetta Luigino, Ora Josuel, Cavalli Francesco, Rogliani Paola, O'Donnell Denis E, Cazzola Mario
Chair of Respiratory Medicine and Unit of Respiratory Clinical Pharmacology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy.
Respir Med. 2017 Aug;129:189-198. doi: 10.1016/j.rmed.2017.06.020. Epub 2017 Jun 29.
The ability to exercise is an important clinical outcome in COPD, and the improvement in exercise capacity is recognized to be an important goal in the management of COPD. Therefore, since the current interest in the use of bronchodilators in COPD is gradually shifting towards the dual bronchodilation, we carried out a meta-analysis to evaluate the impact of LABA/LAMA combination on exercise capacity and lung hyperinflation in COPD.
RCTs were identified after a search in different databases of published and unpublished trials. The aim of this study was to assess the influence of LABA/LAMA combinations on endurance time (ET) and inspiratory capacity (IC), vs. monocomponents.
Eight RCTs including 1632 COPD patients were meta-analysed. LABA/LAMA combinations were significantly (P < 0.05) more effective than the LABA or LAMA alone in terms of the improvement in ET (+43 s and +22 s, respectively) and IC (+107 ml and +87 ml, respectively). LABA/LAMA combinations showed the highest probability of being the best therapy with regard of both ET and IC (100% and 100%, respectively), followed by LAMA (66% and 64%, respectively) and LABA (32% and 36%, respectively), as indicated by the analysis of surface under the cumulative ranking curve (SUCRA). No publication bias was detected in this meta-analysis.
This meta-analysis clearly demonstrates that if the goal of the therapy is to enhance exercise capacity in patients with COPD, LABA/LAMA combinations consistently meet the putative clinically meaningful differences for both ET and IC and, in this respect, are superior to their monocomponents.
运动能力是慢性阻塞性肺疾病（COPD）的一项重要临床指标，运动能力的改善被认为是COPD管理的一个重要目标。因此，鉴于目前COPD中使用支气管扩张剂的兴趣正逐渐转向双重支气管扩张，我们进行了一项荟萃分析，以评估长效β2受体激动剂（LABA）/长效吸入型抗胆碱能药物（LAMA）联合用药对COPD患者运动能力和肺过度充气的影响。
通过检索不同数据库中已发表和未发表的试验来确定随机对照试验（RCT）。本研究的目的是评估LABA/LAMA联合用药与单一成分药物相比，对耐力时间（ET）和吸气容量（IC）的影响。
对8项RCT（共1632例COPD患者）进行了荟萃分析。在改善ET方面（分别增加43秒和22秒）以及IC方面（分别增加107毫升和87毫升），LABA/LAMA联合用药比单独使用LABA或LAMA显著更有效（P < 0.05）。累积排序曲线下面积（SUCRA）分析表明，就ET和IC而言，LABA/LAMA联合用药成为最佳治疗方案的概率最高（分别为100%和100%），其次是LAMA（分别为66%和64%）和LABA（分别为32%和36%）。该荟萃分析未检测到发表偏倚。
这项荟萃分析清楚地表明，如果治疗目标是提高COPD患者的运动能力，LABA/LAMA联合用药在ET和IC方面始终达到假定的具有临床意义的差异，在这方面优于其单一成分药物。
