比较稳定型慢性阻塞性肺疾病中 LAMA/LABA 联合治疗的加重和死亡率：系统评价和贝叶斯网络荟萃分析。
Comparisons of exacerbations and mortality among LAMA/LABA combinations in stable chronic obstructive pulmonary disease: systematic review and Bayesian network meta-analysis.
机构信息
Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro-5-gil, Dongjak-gu, Seoul, 07061, South Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea.
出版信息
Respir Res. 2020 Nov 25;21(1):310. doi: 10.1186/s12931-020-01540-8.
BACKGROUND
Only few randomized controlled trials (RCTs) for head-to-head comparison have been conducted between various combinations of long-acting muscarinic antagonists (LAMAs) and long-acting beta-agonists (LABAs). Our study was conducted to compare acute exacerbation and all-cause mortality among different LAMA/LABA regimens using Bayesian network meta-analysis (NMA).
METHODS
We searched Medline, EMBASE, and the Cochrane library (search date: July 1, 2019). We included parallel-group RCTs comparing LAMA/LABA combinations with other inhaled drugs in the stable COPD for ≥ 48 weeks. Two different network geometries were used. The geometry of network (A) had nodes of individual drugs or their combination, while that of network (B) combined all other treatments except LAMA/LABA into each drug class. This study was prospectively registered in PROSPERO; CRD42019126753.
RESULTS
We included 16 RCTs involving a total of 39,065 patients with stable COPD. Six combinations of LAMA/LABA were identified: tiotropium/salmeterol, glycopyrrolate/indacaterol, umeclidinium/vilanterol, tiotropium/olodaterol, aclidinium/formoterol, and glycopyrrolate/formoterol. We found that umeclidinium/vilanterol was associated with a lower risk of total exacerbations than other LAMA/LABAs in the NMA using network (A) (level of evidence: low or moderate). However, the significant differences were not present in the NMA of network (B). There were no significant differences among the LAMA/LABA combinations in terms of the number of moderate to severe exacerbations, all-cause mortality, major adverse cardiovascular events, or pneumonia.
CONCLUSIONS
The present NMA including all available RCTs provided that there is no strong evidence suggesting different benefits among LAMA/LABAs in patients with stable COPD who have been followed up for 48 weeks or more.
TRIAL REGISTRATION
This study was prospectively registered in PROSPERO; CRD42019126753.
背景
仅有少数头对头比较的随机对照试验（RCT）比较了各种长效抗胆碱能药物（LAMA）和长效β-激动剂（LABA）的组合。我们进行这项研究是为了使用贝叶斯网络荟萃分析（NMA）比较不同 LAMA/LABA 方案的急性加重和全因死亡率。
方法
我们检索了 Medline、EMBASE 和 Cochrane 图书馆（检索日期：2019 年 7 月 1 日）。我们纳入了比较 LAMA/LABA 联合治疗与其他吸入药物在稳定期 COPD 中治疗≥48 周的平行组 RCT。使用了两种不同的网络几何形状。网络（A）的节点是单一药物或其组合，而网络（B）的节点是将除 LAMA/LABA 以外的所有其他治疗方法组合到每个药物类别中。本研究前瞻性地在 PROSPERO 中注册；CRD42019126753。
结果
我们纳入了 16 项 RCT，共纳入 39065 例稳定期 COPD 患者。确定了 6 种 LAMA/LABA 联合治疗：噻托溴铵/沙美特罗、格隆溴铵/茚达特罗、乌美溴铵/维兰特罗、噻托溴铵/奥达特罗、阿地溴铵/福莫特罗和格隆溴铵/福莫特罗。我们发现，在使用网络（A）进行的 NMA 中，与其他 LAMA/LABAs 相比，乌美溴铵/维兰特罗与较低的总加重风险相关（证据水平：低或中）。然而，在网络（B）的 NMA 中没有发现显著差异。在中重度加重、全因死亡率、主要不良心血管事件或肺炎方面，LAMA/LABA 联合治疗之间没有显著差异。
结论
本包括所有可用 RCT 的 NMA 表明，在随访 48 周或更长时间的稳定期 COPD 患者中，LAMA/LABA 之间没有明显的获益差异。
试验注册
本研究前瞻性地在 PROSPERO 中注册；CRD42019126753。
Zotero 插件