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COPD Combination Therapy Compared to Monotherapy

Meta-analysis finds inhaled corticosteroids with long-acting β2-agonists didn't decrease mortality

THURSDAY, Oct. 8 (HealthDay News) -- Treatment with an inhaled corticosteroid (ICS) in combination with long-acting β2-agonist (LABA) did not improve mortality and had more adverse effects than LABA alone in the treatment of severe chronic obstructive pulmonary disease (COPD), according to a meta-analysis in the October issue of Chest.

Gustavo J. Rodrigo, M.D., of Hospital Central de las Fuerzas Armadas in Montevideo, Uruguay, and colleagues screened the literature on the use of LABA/ICS combination treatment for severe COPD. The reviewers conducted a meta-analysis of 18 randomized controlled trials with a total of 12,446 subjects focusing on the primary outcomes of mortality and exacerbations and the secondary outcomes of lung function, quality of life, and adverse effects.

The reviewers concluded that LABA/ICS treatment did not significantly decrease mortality compared to LABA-only treatment in any category, including overall mortality (4.5 versus 5.5 percent), respiratory mortality (1.8 versus 2.4 percent), or cardiovascular mortality (1.6 versus 1.4 percent). Also, LABA/ICS treatment did not significantly decrease severe exacerbations (11.3 versus 12.5 percent), but did reduce moderate exacerbations (17.5 versus 20.1 percent). LABA/ICS treatment was found to increase some adverse effects, including pneumonia (5 versus 3.4 percent), oropharyngeal candidiasis (8.4 versus 7.2 percent), and viral respiratory infections (9.1 versus 7.8 percent).

"Compared with LABA monotherapy, the magnitude of the benefits of LABA/ICS therapy did not reach that of the criteria for predefined clinically important effects and were associated with serious adverse effects," the authors write.

Several study authors reported serving as a lecturer or speaker at a scientific meeting with the sponsorship of multiple pharmaceutical companies.

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