+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis



LABA/LAMA combinations versus LAMA monotherapy or LABA/ICS in COPD: a systematic review and meta-analysis



International Journal of Chronic Obstructive Pulmonary Disease 12: 907-922



Randomized controlled trials (RCTs) indicate that long-acting bronchodilator combinations, such as β2-agonist (LABA)/muscarinic antagonist (LAMA), have favorable efficacy compared with commonly used COPD treatments. The objective of this analysis was to compare the efficacy and safety of LABA/LAMA with LAMA or LABA/inhaled corticosteroid (ICS) in adults with stable moderate-to-very-severe COPD. This systematic review and meta-analysis (PubMed/MEDLINE, Embase, Cochrane Library and clinical trial/manufacturer databases) included RCTs comparing ≥12 weeks' LABA/LAMA treatment with LAMA and/or LABA/ICS (approved doses only). Eligible studies were independently selected by two authors using predefined data fields; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Eighteen studies (23 trials) were eligible (N=20,185). LABA/LAMA significantly improved trough forced expiratory volume in 1 second (FEV1) from baseline to week 12 versus both LAMA and LABA/ICS (0.07 L and 0.08 L, P<0.0001), with patients more likely to achieve clinically important improvements in FEV1 of >100 mL (risk ratio [RR]: 1.33, 95% confidence interval [CI]: [1.20, 1.46] and RR: 1.44, 95% CI: [1.33, 1.56], respectively, the number needed to treat being eight and six, respectively). LABA/LAMA improved transitional dyspnea index and St George's Respiratory Questionnaire scores at week 12 versus LAMA (both P<0.0001), but not versus LABA/ICS, and reduced rescue medication use versus both (P<0.0001 and P=0.001, respectively). LABA/LAMA significantly reduced moderate/severe exacerbation rate compared with LABA/ICS (RR 0.82, 95% CI: [0.75, 0.91]). Adverse event (AE) incidence was no different for LABA/LAMA versus LAMA treatment, but it was lower versus LABA/ICS (RR 0.94, 95% CI: [0.89, 0.99]), including a lower pneumonia risk (RR 0.59, 95% CI: [0.43, 0.81]). LABA/LAMA presented a lower risk for withdrawals due to lack of efficacy versus LAMA (RR: 0.66, 95% CI: [0.51, 0.87]) and due to AEs versus LABA/ICS (RR: 0.83, 95% CI: [0.69, 0.99]). The greater efficacy and comparable safety profiles observed with LABA/LAMA combinations versus LAMA or LABA/ICS support their potential role as first-line treatment options in COPD. These findings are of direct relevance to clinical practice because we included all currently available LABA/LAMAs and comparators, only at doses approved for clinical use.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 059904943

Download citation: RISBibTeXText

PMID: 28360514

DOI: 10.2147/copd.s130482


Related references

Comparative efficacy of inhaled medications (ICS/LABA, LAMA, LAMA/LABA and SAMA) for COPD: a systematic review and network meta-analysis. International Journal of Chronic Obstructive Pulmonary Disease 13: 3203-3231, 2018

Extrafine triple therapy delays COPD clinically important deterioration vs ICS/LABA, LAMA, or LABA/LAMA. International Journal of Chronic Obstructive Pulmonary Disease 14: 531-546, 2019

A Systematic Review With Meta-Analysis of Dual Bronchodilation With LAMA/LABA for the Treatment of Stable COPD. Chest 149(5): 1181-1196, 2016

LABA/LAMA combinations instead of LABA/ICS combinations may prevent or delay exacerbations of COPD in some patients. Evidence-BasedMedicine21(6):222, 2016

LABA/LAMA fixed-dose combinations in patients with COPD: a systematic review. International Journal of Chronic Obstructive Pulmonary Disease 13: 3115-3130, 2018

P59Factors influencing step-up to lama+laba/ics in Copd patients initially on lama monotherapy: a thin database study. Thorax 71(Suppl 3): A116.1-A116, 2016

Characteristics and health care resource use of subjects with COPD in the year before initiating LAMA monotherapy or LAMA+LABA combination therapy: A U.S. database study. Managed Care 27(5): 40-47, 2018

LAMA/LABA vs ICS/LABA in the treatment of COPD in Japan based on the disease phenotypes. International Journal of Chronic Obstructive Pulmonary Disease 10: 1093-1102, 2015

A safety comparison of LABA+LAMA vs LABA+ICS combination therapy for COPD. Expert Opinion on Drug Safety 17(5): 509-517, 2018

Comparative Effectiveness and Safety of LABA-LAMA vs LABA-ICS Treatment of COPD in Real-World Clinical Practice. Chest 155(6): 1158-1165, 2019

A review of current and developing fixed-dose LABA/LAMA combinations for treating COPD. Expert Opinion on PharmacoTherapy 18(17): 1833-1843, 2017

LABA/LAMA combination in COPD: a meta-analysis on the duration of treatment. European Respiratory Review 26(143):, 2017

An update on LAMA/LABA combinations for COPD. Drug and Therapeutics Bulletin 55(1): 2-5, 2017

Rates of escalation to triple COPD therapy among incident users of LAMA and LAMA/LABA. Respiratory Medicine 139: 65-71, 2018

UK-specific cost-effectiveness of tiotropium + olodaterol fixed-dose combination versus other LAMA + LABA combinations in patients with COPD. Clinicoeconomics and Outcomes Research 8: 667-674, 2016