LABA 与 LAMA 治疗稳定期 COPD：系统评价和荟萃分析。

Treatment with LABA versus LAMA for stable COPD: a systematic review and meta-analysis.

机构信息

Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.

Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.

出版信息

BMC Pulm Med. 2020 Apr 29;20(1):111. doi: 10.1186/s12890-020-1152-8.

BACKGROUND

Inhaled bronchodilators including long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) play a central role in the treatment of stable chronic obstructive pulmonary disease (COPD). However, it is still unclear whether LABA or LAMA should be used for the initial treatment. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of LABA versus LAMA in patients with stable COPD.

METHODS

We searched relevant randomized control trials (RCTs) with a period of treatment of at least 12 weeks and analyzed the exacerbations, quality of life, dyspnea score, lung function and adverse events as the outcomes of interest.

RESULTS

We carefully excluded unblinded data and identified a total of 19 RCTs (N = 28,211). LAMA significantly decreased the exacerbations compared to LABA (OR 0.85, 95% CI 0.74 to 0.98; P = 0.02). In St George's Respiratory Questionnaire and transitional dyspnoea index score, there were no differences between LABA and LAMA treatment. Compared to LABA, there was a small but significant increase in the trough FEV after LAMA treatment (Mean difference 0.02, 95% CI 0.01 to 0.03, P = 0.0006). In the safety components, there was no difference in the serious adverse events between LABA and LAMA. However, LAMA showed a significantly lower incidence of total adverse events compared to LABA (OR 0.92, 95% CI 0.86 to 0.98; P = 0.02).

CONCLUSION

Treatment with LAMA in stable COPD provided a significantly lower incidence of exacerbation and non-serious adverse events, and a higher trough FEV compared to LABA.

TRIAL REGISTRATION

(PROSPERO: CRD42019144764).

背景

吸入性支气管扩张剂，包括长效β-激动剂（LABA）和长效抗胆碱能拮抗剂（LAMA），在稳定期慢性阻塞性肺疾病（COPD）的治疗中起着核心作用。然而，对于初始治疗应选择 LABA 还是 LAMA，目前仍不明确。因此，我们进行了一项系统评价和荟萃分析，以评估 LABA 与 LAMA 治疗稳定期 COPD 患者的疗效和安全性。

方法

我们检索了至少治疗 12 周的相关随机对照试验（RCT），并分析了治疗结果，包括急性加重、生活质量、呼吸困难评分、肺功能和不良反应。

结果

我们仔细排除了非盲数据，共确定了 19 项 RCT（N=28211）。与 LABA 相比，LAMA 显著降低了急性加重的发生率（OR 0.85，95%CI 0.74 至 0.98；P=0.02）。在圣乔治呼吸问卷和过渡性呼吸困难指数评分方面，LABA 和 LAMA 治疗之间没有差异。与 LABA 相比，LAMA 治疗后谷值 FEV1 略有但有统计学意义的增加（平均差值 0.02，95%CI 0.01 至 0.03，P=0.0006）。在安全性方面，LABA 和 LAMA 之间严重不良事件的发生率没有差异。然而，与 LABA 相比，LAMA 显示总不良反应的发生率显著降低（OR 0.92，95%CI 0.86 至 0.98；P=0.02）。