Ī range of pharmacological treatment options exists for COPD, with the key treatment goals being to reduce symptoms, decrease the risk of exacerbations, and minimize the impact of exacerbations if they occur. COPD is associated with significant morbidity and mortality: it was reported to be the third leading cause of death in 2016, causing an estimated 3.0 million deaths globally. The results of this network meta-analysis provide important context for healthcare providers and payers in evaluating the current evidence regarding triple therapies in COPD.Ĭhronic obstructive pulmonary disease (COPD) is a progressive disease that causes symptoms including dyspnea, sputum production, and chronic cough, and can be associated with significant comorbidities. On the basis of evidence from 18 studies, BGF MDI was found to have similar efficacy to other fixed-dose and open triple combination therapies in reducing exacerbations and improving lung function and symptoms in patients with moderate to very severe COPD. We performed a network meta-analysis to compare the relative efficacy of BGF MDI versus other triple therapies (in fixed-dose or open combination) in patients with moderate to very severe COPD. Given the relatively recent introduction of fixed-dose triple therapies for COPD, there are no head-to-head randomized controlled trials of their relative efficacy. Further research is warranted as additional evidence regarding triple therapies, especially fixed-dose combinations, becomes available.īudesonide/glycopyrronium/formoterol fumarate metered dose inhaler (BGF MDI) is a triple fixed-dose combination therapy for chronic obstructive pulmonary disease (COPD). This NMA suggested that BGF MDI has comparable efficacy to other ICS/LAMA/LABA fixed-dose and open triple combination therapies in reducing exacerbations and improving lung function and symptoms in patients with moderate to very severe COPD. Results from sensitivity analyses and meta-regression were consistent with the base-case scenario. Across all outcomes, there were no statistically significant differences between BGF MDI and other triple ICS/LAMA/LABA fixed-dose (fluticasone furoate/umeclidinium/vilanterol and beclomethasone dipropionate/glycopyrronium/formoterol fumarate) and open combinations with data available within the network. ICS/LABA dual combinations were combined as a single treatment group to create a connected network. ResultsĮighteen studies ( n = 29,232 patients) contributed to the NMA.
Meta-regression and sensitivity analyses were used to assess heterogeneity across studies. Change from baseline in rescue medication use over weeks 12–24 was also analyzed.
George’s Respiratory Questionnaire (SGRQ) total score proportion of SGRQ responders and Transition Dyspnea Index focal score. A three-level hierarchical Bayesian NMA model was used to determine the exacerbation rate per patient per year as well as the following outcomes at week 24: changes from baseline in pre-dose trough forced expiratory volume in 1 s (FEV 1), post-dose peak FEV 1, and St. Studies were assessed for methodological quality and risk of bias.
MethodsĪ systematic literature review was conducted to identify randomized controlled trials of at least 10-week duration, including at least one fixed-dose or open combination triple therapy arm, in patients with moderate to very severe COPD. The relative efficacy of budesonide/glycopyrronium/formoterol fumarate metered dose inhaler 320/18/9.6 µg (BGF MDI) in COPD was compared with other ICS/LAMA/LABA fixed-dose and open combination therapies in a network meta-analysis (NMA). Triple inhaled corticosteroid/long-acting muscarinic antagonist/long-acting β 2-agonist (ICS/LAMA/LABA) combination therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) who experience further exacerbations/symptoms on dual LAMA/LABA or ICS/LABA therapy.
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