COPD exacerbations: LABA and LAMA combo fares better than monotherapy

The combination therapy with long-acting bronchodilators such as long-acting β-agonist (LABA), long-acting muscarinic antagonist (LAMA) was the highest ranked treatment group to reduce COPD exacerbations than monotherapies for improving symptoms and quality‐of‐life scores, according to the findings of a systematic review and meta-analysis published in Cochrane.

The analysis revealed that combination inhalers (LABA/LAMA and LABA/inhaled corticosteroid [ICS]), appear more effective for controlling symptoms in patients with prior exacerbations than monotherapies with LAMA or LABA. Also, ICS-containing inhalers are associated with an increased risk for pneumonia. Moreover, inhalers containing LAMA have an advantage over inhalers without LAMA in the prevention of exacerbations in COPD.

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A number of LABA/LAMA combinations are now available for clinical use in COPD. However, it was not clear which group of above-mentioned inhalers was most effective or if any specific formulation worked better than the others within the same group or class.

Yuji Oba and his associates performed a network meta-analysis to compare the efficacy and safety of available formulations from four different groups of inhalers (i.e. LABA/LAMA combination, LABA/ICS combination, LAMA, and LABA) in people with moderate to severe COPD. The review will update previous systematic reviews on dual combination inhalers and long‐acting bronchodilators.

The analysis included randomized controlled trials (RCTs) that recruited people aged 35 years or older with a diagnosis of COPD and a baseline forced expiratory volume in one second (FEV1) of less than 80% of predicted. The investigators included the studies of at least 12 weeks' duration including at least two active comparators from one of the four inhaler groups.

A total of 101,311 participants from 99 studies found its place in the systematic review.

The NMAs suggested that the LABA/LAMA combination was the highest ranked treatment group to reduce COPD exacerbations followed by LAMA in both populations.

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There was evidence that the LABA/LAMA combination decreased moderately to severe exacerbations compared to LABA/ICS combination, LAMA, and LABA in the high‐risk population. There was a general trend towards greater improvement in symptom and quality‐of‐life scores with the combination therapies compared to monotherapies, and the combination therapies were generally ranked higher than monotherapies. The LABA/ICS combination was the lowest ranked in pneumonia serious adverse events (SAEs) in both populations. There was evidence that the LABA/ICS combination increases the odds of pneumonia compared to the LAMA/LABA combination, LAMA, and LABA.

“Our most comprehensive review including intraclass/group comparisons, free combination therapies, 99 studies, and 20 outcomes for each high‐ and low‐risk population summarises the current literature and could help with updating existing COPD guidelines,” write the authors.

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https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012620.pub2/full