Pan Qiong, Sun Jiongzhou, Gao Shiyuan, Liu Zian, Huang Yiwen, Lian Yixin
Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
Arch Med Sci. 2024 May 28;20(5):1586-1596. doi: 10.5114/aoms/183025. eCollection 2024.
The latest evidence revealed that dupilumab, an interleukin-4 (IL-4) and interleukin-13 (IL-13) blocker, significantly reduces the exacerbation risk in patients with chronic obstructive pulmonary disease (COPD). The efficacy of dupilumab compared with conventional inhaled drugs remains incompletely determined. This study aimed to investigate the comparative efficacy of dupilumab and conventional inhaled drugs in patients with stable COPD.
This study retrieved randomised clinical trials (RCTs) with follow-up ≥ 48 weeks on long-acting β-agonists (LABAs), long-acting muscarinic receptor antagonists (LAMAs), inhaled corticosteroids (ICSs), and dupilumab in the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases. The information on eligible studies was extracted after the screening. The comparative efficacy of 4 drugs and their combinations in acute exacerbation and mortality was assessed using Bayesian network meta-analysis models.
This network meta-analysis identified 69 eligible RCTs on 7 classes of drug therapies after stepwise screening and included 125,331 COPD patients. Compared with placebo, the 7 drug interventions significantly reduced the risk of acute exacerbation, and the reduction degree increased with the incremental use of drug classes. ICS/LABA/LAMA/dupilumab was the most effective in decreasing exacerbation risk (OR = 0.561 [95% CI: 0.387-0.810]), followed by ICS/LABA/LAMA (OR = 0.717 [95% CI: 0.626-0.817]). The 7 drug therapies were not significantly associated with a lower risk of death compared to placebo. Nevertheless, ICS/LABA/LAMA/dupilumab is the most likely to be effective in decreasing mortality.
The incremental use of combinations of conventional and novel drugs contributed to the long-term benefits in acute exacerbation but not death in COPD. The optimal drug combination in terms of acute COPD exacerbation was ICS/LABA/LAMA/dupilumab.
最新证据显示，度普利尤单抗（一种白细胞介素-4（IL-4）和白细胞介素-13（IL-13）阻滞剂）可显著降低慢性阻塞性肺疾病（COPD）患者的急性加重风险。度普利尤单抗与传统吸入药物相比的疗效仍未完全确定。本研究旨在探讨度普利尤单抗与传统吸入药物对稳定期COPD患者的相对疗效。
本研究在PubMed、EMBASE和Cochrane对照试验中央注册库数据库中检索了关于长效β受体激动剂（LABA）、长效毒蕈碱受体拮抗剂（LAMA）、吸入性糖皮质激素（ICS）和度普利尤单抗且随访时间≥48周的随机临床试验（RCT）。筛选后提取符合条件研究的信息。使用贝叶斯网络荟萃分析模型评估4种药物及其组合在急性加重和死亡率方面的相对疗效。
经过逐步筛选，该网络荟萃分析确定了7类药物治疗的69项符合条件的RCT，纳入了125331例COPD患者。与安慰剂相比，这7种药物干预均显著降低了急性加重风险，且随着药物种类使用的增加，降低程度增大。ICS/LABA/LAMA/度普利尤单抗在降低急性加重风险方面最有效（OR = 0.561 [95% CI：0.387 - 0.810]），其次是ICS/LABA/LAMA（OR = 0.717 [95% CI：0.626 - 0.817]）。与安慰剂相比，这7种药物治疗与较低的死亡风险无显著相关性。然而，ICS/LABA/LAMA/度普利尤单抗在降低死亡率方面最有可能有效。
传统药物与新型药物联合使用的增加有助于COPD患者在急性加重方面获得长期益处，但对死亡率无影响。就COPD急性加重而言，最佳药物组合是ICS/LABA/LAMA/度普利尤单抗。
