Comparative Efficacy of Combination Bronchodilator Therapies in COPD: a Network Meta-analysis

Overview

Journal Int J Chron Obstruct Pulmon Dis

Publisher Dove Medical Press

Specialty Pulmonary Medicine

Date 2015 Sep 23

PMID 26392761

Citations 12

Authors

Eline L Huisman

Sarah M Cockle

Afisi S Ismaila

Andreas Karabis

Yogesh Suresh Punekar

Affiliations

Soon will be listed here.

Abstract

Background: Several new fixed-dose combination bronchodilators have been recently launched, and assessing their efficacy relative to each other, and with open dual combinations is desirable. This network meta-analysis (NMA) assessed the efficacy of umeclidinium and vilanterol (UMEC/VI) with that of available dual bronchodilators in single/separate inhalers.

Methods: A systematic literature review identified randomized controlled trials of ≥10 weeks among chronic obstructive pulmonary disease patients (≥40 years), assessing the efficacy of combination bronchodilators in single or separate inhalers. Comparative assessment was conducted on change from baseline in trough forced expiratory volume in 1 second (FEV1), St George's Respiratory Questionnaire (SGRQ) total scores, transitional dyspnea index (TDI) focal scores, and rescue medication use at 12 weeks and 24 weeks using an NMA within a Bayesian framework.

Results: A systematic literature review identified 77 articles of 26 trials comparing UMEC/VI, indacaterol/glycopyrronium (QVA149), formoterol plus tiotropium (TIO) 18 μg, salmeterol plus TIO, or indacaterol plus TIO, with TIO and placebo as common comparators at 12 weeks and approximately 24 weeks. The NMA showed that at 24 weeks, efficacy of UMEC/VI was not significantly different compared with QVA149 on trough FEV1 (14.1 mL [95% credible interval: -14.2, 42.3]), SGRQ total score (0.18 [-1.28, 1.63]), TDI focal score (-0.30 [-0.73, 0.13]), and rescue medication use (0.02 [-0.27, 0.32]); compared with salmeterol plus TIO on trough FEV1 (67.4 mL [-25.3, 159.4]), SGRQ total score (-0.11 [-1.84, 1.61]), and TDI focal score (0.58 [-0.33, 1.50]); and compared with formoterol plus TIO 18 μg on SGRQ total score (-0.68 [-1.77, 0.39]). Results at week 12 were consistent with week 24 outcomes. Due to lack of availability of evidence, no comparison was made with formoterol plus TIO on FEV1 or TDI at 24 weeks.

Conclusion: UMEC/VI has comparable efficacy to other dual-bronchodilator combinations on available efficacy endpoints.

Citing Articles

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Kerwin E, Jones P, Bjermer L, Maltais F, Boucot I, Naya I Chron Respir Dis. 2023; 20:14799731231202257.

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Bourdin A, Molinari N, Ferguson G, Singh B, Siddiqui M, Holmgren U Adv Ther. 2021; 38(6):3089-3112.

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The effect of long-acting dual bronchodilator therapy on exercise tolerance, dynamic hyperinflation, and dead space during constant work rate exercise in COPD.

Stringer W, Porszasz J, Cao M, Rossiter H, Siddiqui S, Rennard S J Appl Physiol (1985). 2021; 130(6):2009-2018.

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Efficacy and Safety of LAMA/LABA Fixed-Dose Combination Therapies in Chronic Obstructive Pulmonary Disease: A Systematic Review of Direct and Indirect Treatment Comparisons.

Hurst J, Gruffydd-Jones K, Biswas M, Guranlioglu D, Jenkins M, Stjepanovic N Int J Chron Obstruct Pulmon Dis. 2020; 15:1529-1543.

PMID: 32669839 PMC: 7336124. DOI: 10.2147/COPD.S230955.

A Network Meta-Analysis of Long-Acting Muscarinic Antagonist (LAMA) and Long-Acting β-Agonist (LABA) Combinations in COPD.

Sion K, Huisman E, Punekar Y, Naya I, Ismaila A Pulm Ther. 2020; 3(2):297-316.

PMID: 32026346 PMC: 6964204. DOI: 10.1007/s41030-017-0048-0.

References

Karabis A, Lindner L, Mocarski M, Huisman E, Greening A . Comparative efficacy of aclidinium versus glycopyrronium and tiotropium, as maintenance treatment of moderate to severe COPD patients: a systematic review and network meta-analysis. Int J Chron Obstruct Pulmon Dis. 2013; 8:405-23. PMC: 3772873. DOI: 10.2147/COPD.S48967. View

Tashkin D, Celli B, Senn S, Burkhart D, Kesten S, Menjoge S . A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008; 359(15):1543-54. DOI: 10.1056/NEJMoa0805800. View

Cope S, Zhang J, Saletan S, Smiechowski B, Jansen J, Schmid P . A process for assessing the feasibility of a network meta-analysis: a case study of everolimus in combination with hormonal therapy versus chemotherapy for advanced breast cancer. BMC Med. 2014; 12:93. PMC: 4077675. DOI: 10.1186/1741-7015-12-93. View

Cazzola M, Noschese P, Salzillo A, De Giglio C, DAmato G, Matera M . Bronchodilator response to formoterol after regular tiotropium or to tiotropium after regular formoterol in COPD patients. Respir Med. 2005; 99(5):524-8. DOI: 10.1016/j.rmed.2004.10.004. View

Casaburi R, Mahler D, Jones P, Wanner A, San P, ZuWallack R . A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease. Eur Respir J. 2002; 19(2):217-24. DOI: 10.1183/09031936.02.00269802. View

Kelleher D, Mehta R, Jean-Francois B, Preece A, Blowers J, Crater G . Safety, tolerability, pharmacodynamics and pharmacokinetics of umeclidinium and vilanterol alone and in combination: a randomized crossover trial. PLoS One. 2013; 7(12):e50716. PMC: 3524248. DOI: 10.1371/journal.pone.0050716. View

Bateman E, Ferguson G, Barnes N, Gallagher N, Green Y, Henley M . Dual bronchodilation with QVA149 versus single bronchodilator therapy: the SHINE study. Eur Respir J. 2013; 42(6):1484-94. PMC: 3844137. DOI: 10.1183/09031936.00200212. View

Dahl R, Chapman K, Rudolf M, Mehta R, Kho P, Alagappan V . Safety and efficacy of dual bronchodilation with QVA149 in COPD patients: the ENLIGHTEN study. Respir Med. 2013; 107(10):1558-67. DOI: 10.1016/j.rmed.2013.05.016. View

Mahler D, DUrzo A, Bateman E, Ozkan S, White T, Peckitt C . Concurrent use of indacaterol plus tiotropium in patients with COPD provides superior bronchodilation compared with tiotropium alone: a randomised, double-blind comparison. Thorax. 2012; 67(9):781-8. DOI: 10.1136/thoraxjnl-2011-201140. View

10.

Celli B, Decramer M, Kesten S, Liu D, Mehra S, Tashkin D . Mortality in the 4-year trial of tiotropium (UPLIFT) in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009; 180(10):948-55. DOI: 10.1164/rccm.200906-0876OC. View

11.

Niewoehner D, Rice K, Cote C, Paulson D, Cooper Jr J, Korducki L . Prevention of exacerbations of chronic obstructive pulmonary disease with tiotropium, a once-daily inhaled anticholinergic bronchodilator: a randomized trial. Ann Intern Med. 2005; 143(5):317-26. DOI: 10.7326/0003-4819-143-5-200509060-00007. View

12.

Moita J, Barbara C, Cardoso J, Costa R, Sousa M, Ruiz J . Tiotropium improves FEV1 in patients with COPD irrespective of smoking status. Pulm Pharmacol Ther. 2007; 21(1):146-51. DOI: 10.1016/j.pupt.2007.04.003. View

13.

Decramer M, Anzueto A, Kerwin E, Kaelin T, Richard N, Crater G . Efficacy and safety of umeclidinium plus vilanterol versus tiotropium, vilanterol, or umeclidinium monotherapies over 24 weeks in patients with chronic obstructive pulmonary disease: results from two multicentre, blinded, randomised controlled trials. Lancet Respir Med. 2014; 2(6):472-86. DOI: 10.1016/S2213-2600(14)70065-7. View

14.

Brusasco V, Hodder R, Miravitlles M, Korducki L, Towse L, Kesten S . Health outcomes following treatment for six months with once daily tiotropium compared with twice daily salmeterol in patients with COPD. Thorax. 2003; 58(5):399-404. PMC: 1746668. DOI: 10.1136/thorax.58.5.399. View

15.

Maleki-Yazdi M, Kaelin T, Richard N, Zvarich M, Church A . Efficacy and safety of umeclidinium/vilanterol 62.5/25 mcg and tiotropium 18 mcg in chronic obstructive pulmonary disease: results of a 24-week, randomized, controlled trial. Respir Med. 2014; 108(12):1752-60. DOI: 10.1016/j.rmed.2014.10.002. View

16.

Dias S, Sutton A, Ades A, Welton N . Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials. Med Decis Making. 2012; 33(5):607-17. PMC: 3704203. DOI: 10.1177/0272989X12458724. View

17.

Tashkin D, Pearle J, Iezzoni D, Varghese S . Formoterol and tiotropium compared with tiotropium alone for treatment of COPD. COPD. 2009; 6(1):17-25. DOI: 10.1080/15412550902724073. View

18.

Vogelmeier C, Kardos P, Harari S, Gans S, Stenglein S, Thirlwell J . Formoterol mono- and combination therapy with tiotropium in patients with COPD: a 6-month study. Respir Med. 2008; 102(11):1511-20. DOI: 10.1016/j.rmed.2008.07.020. View

19.

Kew K, Dias S, Cates C . Long-acting inhaled therapy (beta-agonists, anticholinergics and steroids) for COPD: a network meta-analysis. Cochrane Database Syst Rev. 2014; (3):CD010844. PMC: 10879916. DOI: 10.1002/14651858.CD010844.pub2. View

20.

Tashkin D, Ferguson G . Combination bronchodilator therapy in the management of chronic obstructive pulmonary disease. Respir Res. 2013; 14:49. PMC: 3651866. DOI: 10.1186/1465-9921-14-49. View