LABA/LAMA combination in COPD: a meta-analysis on the duration of treatment

摘要

When there are no randomised clinical trials directly comparing all relevant treatment options; an indirect treatment comparison via meta-analysis of the available clinical evidence is an acceptable alternative. However; meta-analyses may be very misleading if not adequately performed. Here; we propose and validate a simple and effective approach to meta-analysis for exploring the effectiveness of long-acting xcexb22-agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combinations in chronic obstructive pulmonary disease.14 articles with 20xe2x80x8a329 patients (combinations n=9292; monocomponents n=11xe2x80x8a037) were included in this study. LABA/LAMA combinations were always more effective than the monocomponents in terms of the improvement in trough forced expiratory volume in 1xe2x80x85s; transition dyspnoea index and St George's Respiratory Questionnaire scores after 3; 6 and 12xe2x80x85months of treatment. No significant publication bias was identified. Significant discrepancies with previous network meta-analyses have been found; with overall differences ranging from 26.7% to 43.3%.Results from previous network meta-analyses were misleading because no adequate attention was given to formulating the review question; specifying eligibility criteria; correctly identifying studies; collecting appropriate information and deciding what it would be pharmacologically relevant to analyse. The real gradient of effectiveness of LABA/LAMA fixed-dose combinations remains an unmet medical need; however; it can be investigated indirectly using a high-quality meta-analytic approach.