Impact of LABA/LAMA combination on exercise endurance and lung hyperinflation in COPD: A pair-wise and network meta-analysis. (August 2017)

• Record Type: Journal Article
• Authors: Calzetta, Luigino; Ora, Josuel; Cavalli, Francesco; Rogliani, Paola; O'Donnell, Denis E.; Cazzola, Mario
• Is Part Of: Respiratory medicine. Volume 129(2017)
• Page Start: 189
• Page End: 198
• Publication Date: 2017-08
• Subjects: COPD -- Exercise -- LABA -- LAMA -- Combination -- Meta-analysis; COPD chronic obstructive pulmonary disease -- CPET cardiopulmonary exercise test -- ET endurance time -- ESWT endurance shuttle walking test -- FDC fixed-dose combinations -- FEV1 forced expiratory volume in one second -- HRQoL health-related quality of life -- IC inspiratory capacity -- ISWT incremental shuttle walking test -- LABA long-acting β2-agonist -- LAMA long-acting muscarinic antagonists -- MCID minimal clinical important difference -- MD mean difference -- OIS optimal information size -- PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses -- RCT randomised clinical trial -- RE relative effect -- SE standard error -- SMD standardized mean difference -- SGRQ St. George's Respiratory Questionnaire -- SUCRA surface under the cumulative ranking curve -- TDI transition dyspnea index -- Tlim limit of tolerance -- 95%CI 95% confidence interval -- 95%Crl 95% credible level; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2017.06.020
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: The ability to exercise is an important clinical outcome in COPD, and the improvement in exercise capacity is recognized to be an important goal in the management of COPD. Therefore, since the current interest in the use of bronchodilators in COPD is gradually shifting towards the dual bronchodilation, we carried out a meta-analysis to evaluate the impact of LABA/LAMA combination on exercise capacity and lung hyperinflation in COPD. Methods: RCTs were identified after a search in different databases of published and unpublished trials. The aim of this study was to assess the influence of LABA/LAMA combinations on endurance time (ET) and inspiratory capacity (IC), vs. monocomponents. Results: Eight RCTs including 1632 COPD patients were meta-analysed. LABA/LAMA combinations were significantly (P < 0.05) more effective than the LABA or LAMA alone in terms of the improvement in ET (+43 s and +22 s, respectively) and IC (+107 ml and +87 ml, respectively). LABA/LAMA combinations showed the highest probability of being the best therapy with regard of both ET and IC (100% and 100%, respectively), followed by LAMA (66% and 64%, respectively) and LABA (32% and 36%, respectively), as indicated by the analysis of surface under the cumulative ranking curve (SUCRA). No publication bias was detected in this meta-analysis. Conclusions: This meta-analysis clearly demonstrates that if the goal of the therapy is to enhance exercise capacity in patients with COPD, LABA/LAMA combinations consistently meet the putative clinically meaningful differences for both ET and IC and, in this respect, are superior to their monocomponents. Highlights: LABA/LAMA FDCs always meet the putative minimal clinical difference for both ET and IC, being superior to monocomponents. For COPD patients with persistent dyspnea and exercise intolerance, LABA/LAMA FDCs are a practical first step choice. The best test for assessing the impact of a therapeutic intervention on exercise capacity must still be determined.