Yamasaki Akira, Tomita Katsuyuki, Inui Genki, Okazaki Ryota, Harada Tomoya
Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori, Japan.
Department of Respiratory Medicine, National Hospital Organization Yonago Medical Center, Tottori, Japan.
Heliyon. 2024 May 16;10(12):e31186. doi: 10.1016/j.heliyon.2024.e31186. eCollection 2024 Jun 30.
The effectiveness of different combinations of inhaled corticosteroid (ICS) therapies in reducing severe exacerbations of adult asthma remains unclear.
This network meta-analysis (NMA) extensively evaluated the treatment effects of single ICS; dual ICS i.e., ICS/long-acting β2-adrenergic agonists (LABA); ICS/LABA as single maintenance and reliever therapy (SMART); and triple ICS, i.e., ICS/LABA/long-acting muscarinic antagonists (LAMA) in preventing severe asthma exacerbations.
A systematic search of English databases, including PubMed and Web of Science, was conducted until December 31, 2022, using PRISMA-NMA.
Using the PICOS criteria, the questions for this study were carefully selected so that the correct keywords could be identified.
A pairwise meta-analysis was used to select trials based on the criteria for minimizing heterogeneity (I). Subsequently, the "BUGSnet" package of R software was used to perform a Bayesian network meta-analysis.
The main outcome measures were risk rate and annualized rate ratio of severe asthma exacerbations.
This review included 56 randomized control trials (RCTs; n = 78,171 patients). As the pairwise meta-analysis demonstrated that the annualized rate ratio of severe asthma exacerbation had moderate heterogeneity, we analyzed the risk rate of severe asthma exacerbation using a network meta-analysis. In terms of direct/indirect comparisons with non-ICS, single ICS, dual ICS, SMART, and triple ICS reduced severe asthma exacerbations by 34 %, 47 %, 58 %, and 57 %, respectively. SMART and triple ICS showed high effectiveness in reducing severe exacerbations.
AND RELEVANCE: SMART and triple ICS were ranked higher in effectiveness in reducing severe asthma exacerbations in comparison with other therapies, indicating that these are the most effective treatments for reducing the future risk of severe asthma exacerbations.
吸入性糖皮质激素（ICS）不同联合疗法在降低成人哮喘严重发作方面的有效性仍不明确。
本网状Meta分析（NMA）广泛评估了单一ICS、双重ICS（即ICS/长效β2肾上腺素能激动剂[LABA]）、作为单药维持和缓解治疗（SMART）的ICS/LABA以及三联ICS（即ICS/LABA/长效毒蕈碱拮抗剂[LAMA]）预防严重哮喘发作的治疗效果。
采用PRISMA-NMA对包括PubMed和Web of Science在内的英文数据库进行系统检索，直至2022年12月31日。
使用PICOS标准，仔细选择本研究的问题，以便确定正确的关键词。
采用成对Meta分析，根据最小化异质性（I）的标准选择试验。随后，使用R软件的“BUGSnet”包进行贝叶斯网状Meta分析。
主要结局指标为严重哮喘发作的风险率和年化率比。
本综述纳入了56项随机对照试验（RCT；n = 78171例患者）。由于成对Meta分析表明严重哮喘发作的年化率比具有中度异质性，我们使用网状Meta分析分析了严重哮喘发作的风险率。与非ICS进行直接/间接比较时，单一ICS、双重ICS、SMART和三联ICS分别将严重哮喘发作减少了34%、47%、58%和57%。SMART和三联ICS在减少严重发作方面显示出高效性。
与其他疗法相比，SMART和三联ICS在降低严重哮喘发作方面的有效性排名更高，表明这些是降低未来严重哮喘发作风险的最有效治疗方法。
