However, the significant differences were not present in the NMA of network (B). We found that umeclidinium/vilanterol was associated with a lower risk of total exacerbations than other LAMA/LABAs in the NMA using network (A) (level of evidence: low or moderate). Six combinations of LAMA/LABA were identified: tiotropium/salmeterol, glycopyrrolate/indacaterol, umeclidinium/vilanterol, tiotropium/olodaterol, aclidinium/formoterol, and glycopyrrolate/formoterol. We included 16 RCTs involving a total of 39,065 patients with stable COPD. This study was prospectively registered in PROSPERO CRD42019126753. The geometry of network (A) had nodes of individual drugs or their combination, while that of network (B) combined all other treatments except LAMA/LABA into each drug class. Two different network geometries were used. We included parallel-group RCTs comparing LAMA/LABA combinations with other inhaled drugs in the stable COPD for ≥ 48 weeks. We searched Medline, EMBASE, and the Cochrane library (search date: July 1, 2019). Our study was conducted to compare acute exacerbation and all-cause mortality among different LAMA/LABA regimens using Bayesian network meta-analysis (NMA). In spite of these indications, LABA/ICS inhalers remain the second most commonly prescribed first-line treatments (after LAMA monotherapy) across the range of COPD severities, because its use has been associated with an increased risk of pneumonia.Only few randomized controlled trials (RCTs) for head-to-head comparison have been conducted between various combinations of long-acting muscarinic antagonists (LAMAs) and long-acting beta-agonists (LABAs). On the other hand, LABA-ICS combinations are indicated for patients with severe-to-very-severe disease and a history of repeated exacerbations. Additionally, they prevent exacerbations and increase exercise endurance by reducing pulmonary hyperinflation and dyspnoea. Use of LABA-LAMA inhalers are crucial to symptom management in COPD, improving lung function and health-related quality of life. However, results for the incidence of severe pneumonia requiring hospitalization were better with LABA-LAMA (HR, 0.66 0.41–1.05), particularly in the on-treatment analysis (HR, 0.66 0.50–0.87). In multivariable Cox analysis the respective hazard ratios (HRs) for moderate and severe COPD exacerbations associated with LABA-LAMA initiation vs LABA-ICS initiation were 1.04 (95 percent CI, 0.90–1.20) and 0.94 (0.65–1.36). There was no significant difference in the incidence of exacerbations between the two groups. Researchers used data from the United Kingdom’s Clinical Practice Research Datalink and identified 1,977 initiators of LABA-LAMA and 1,977 matched initiators of LABA-ICS.Īll patients were aged ≥55 years and followed for 12 months for the occurrence of a moderate or severe COPD exacerbation and severe pneumonia.
#LABA LAMA DIFFERENCE BETWEEN PLUS#
Long-acting beta 2-agonist (LABA) plus long-acting muscarinic antagonist (LAMA) combinations compare with inhalers containing both LABA and corticosteroid (LABA-ICS) in terms of reducing chronic obstructive pulmonary disease (COPD) exacerbations, although the LAMA-LABA combination is more favourable as it is associated with fewer episodes of severe pneumonia, according to a study.
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