ICS/LABA combination reduces mortality in COPD
MedWire News: Treatment with an inhaled corticosteroid (ICS) and long-acting beta-2 agonist (LABA) combination significantly reduces mortality in patients with chronic obstructive pulmonary disease (COPD), results from a systematic review and meta-analysis show.
However, treatment with long-acting bronchodilators alone had no significant affect on mortality in patients with the respiratory condition, reports the team in the journal Respiratory Research.
“Expert guidelines recommend the use of long-acting bronchodilators as first-line therapies for [COPD] patients with persistent symptoms. However, their effect on mortality remains controversial,” explain Don Sin (University of British Columbia, Vancouver, Canada) and colleagues.
The researchers searched the literature for randomized controlled trials of tiotropium, formoterol, salmeterol, formoterol/budesonide or salmeterol/fluticasone for the treatment of COPD that had a follow-up period of at least 6 months and included data on mortality.
In total, 27 studies involving more than 30,000 participants were included in the final analysis.
Examination of the pooled data revealed that combined ICS/LABA treatment was associated with a significantly reduced mortality risk compared with placebo, at a relative risk (RR) of 0.80.
However, treatment with the long-acting anticholinergic tiotropium or LABAs alone was not associated with significant reductions in mortality, at respective RRs of 1.08 and 0.90.
Sin and team conclude: “The most important findings from the present meta-analysis were that… ICSs in combination with a LABA were associated with a 20% reduction in total mortality, whereas LABAs or long-acting anticholinergics by themselves did not alter mortality.”
Nevertheless, they add: “The survival effect, however, is fairly modest and suggests a pressing need for additional pharmacotherapies that can reduce the overall mortality in COPD, which in less than 10 years will be the third leading cause of death worldwide.”
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By Mark Cowen