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2015 ; 10
(ä): 2495-517
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gab.com Text
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Comparative efficacy of long-acting muscarinic antagonist monotherapies in COPD:
a systematic review and network meta-analysis
#MMPMID26604738
Ismaila AS
; Huisman EL
; Punekar YS
; Karabis A
Int J Chron Obstruct Pulmon Dis
2015[]; 10
(ä): 2495-517
PMID26604738
show ga
BACKGROUND: Randomized, controlled trials comparing long-acting muscarinic
antagonist (LAMA) efficacy in COPD are limited. This network meta-analysis (NMA)
assessed the relative efficacy of tiotropium 18 µg once-daily (OD) and newer
agents (aclidinium 400 µg twice-daily, glycopyrronium 50 µg OD, and umeclidinium
62.5 µg OD). METHODS: A systematic literature review identified randomized,
controlled trials of adult COPD patients receiving LAMAs. A NMA within a Bayesian
framework examined change from baseline in trough forced expiratory volume in 1
second (FEV1), transitional dyspnea index focal score, St George's Respiratory
Questionnaire score, and rescue medication use. RESULTS: Twenty-four studies
(n=21,311) compared LAMAs with placebo/each other. Aclidinium, glycopyrronium,
tiotropium, and umeclidinium, respectively, demonstrated favorable results versus
placebo, for change from baseline (95% credible interval) in 12-week trough FEV1
(primary endpoint: 101.40 mL [77.06-125.60]; 117.20 mL [104.50-129.90]; 114.10 mL
[103.10-125.20]; 136.70 mL [104.20-169.20]); 24-week trough FEV1 (128.10 mL
[84.10-172.00]; 135.80 mL [123.10-148.30]; 106.40 mL [95.45-117.30]; 115.00 mL
[74.51-155.30]); 24-week St George's Respiratory Questionnaire score (-4.60
[-6.76 to -2.54]; -3.14 [-3.83 to -2.45]; -2.43 [-2.92 to -1.93]; -4.69 [-7.05 to
-2.31]); 24-week transitional dyspnea index score (1.00 [0.41-1.59]; 1.01
[0.79-1.22]; 0.82 [0.62-1.02]; 1.00 [0.49-1.51]); and 24-week rescue medication
use (data not available; -0.41 puffs/day [-0.62 to -0.20]; -0.52 puffs/day [-0.74
to -0.30]; -0.30 puffs/day [-0.81 to 0.21]). For 12-week trough FEV1, differences
in change from baseline (95% credible interval) were -12.8 mL (-39.39 to 13.93),
aclidinium versus tiotropium; 3.08 mL (-7.58 to 13.69), glycopyrronium versus
tiotropium; 22.58 mL (-11.58 to 56.97), umeclidinium versus tiotropium; 15.90 mL
(-11.60 to 43.15), glycopyrronium versus aclidinium; 35.40 mL (-5.06 to 76.07),
umeclidinium versus aclidinium; and 19.50 mL (-15.30 to 54.38), umeclidinium
versus glycopyrronium. Limitations included inhaler-related factors and safety;
longer-term outcomes were not considered. CONCLUSION: The new LAMAs studied had
at least comparable efficacy to tiotropium, the established class standard.
Choice should depend on physician's and patient's preference.