OBJECTIVES: To compare the effectiveness of budesonide/formoterol (Symbicort) for Maintenance and Reliever Therapy (Symbicort SMART) Turbuhaler with twice daily inhaled corticosteroid (ICS) treatment, alone or in combination with a long-acting beta(2)-agonist (LABA). METHODS: Meta analysis of randomised controlled trials (RCTs) using a fixed effects model. RCTs were included if the comparator with budesonide/formoterol for maintenance and relief had the equivalent, or up to fourfold higher, maintenance dose of ICS. The primary outcome was the incidence of severe exacerbation (oral glucocorticosteroid treatment for > or = 3 days, emergency visit and/or hospitalisation). RESULTS: Of the seven RCTs available six met the inclusion criteria. Risk of severe exacerbations was significantly reduced: 41% vs. higher-dose budesonide alone [relative risk (RR) 0.59, 95% confidence interval (95% CI): 0.51-0.68, p < 0.00001]; 43% vs. equivalent dose budesonide/formoterol as maintenance twice daily (RR 0.57, 95% CI: 0.49-0.66, p < 0.00001); 24% vs. higher-dose salmeterol/fluticasone twice daily (RR 0.76, 95% CI: 0.64-0.90, p = 0.002); and 26% vs. higher-dose budesonide/formoterol twice daily (RR 0.74, 95% CI: 0.58-0.96, p = 0.02). Significant heterogeneity was not detected in the primary analyses (p > 0.1). Secondary analyses also demonstrated that budesonide/formoterol for maintenance and relief reduced the most severe exacerbations, resulting in less hospitalisations/accident and emergency visits than higher-dose budesonide, equivalent dose budesonide/formoterol and higher-dose salmeterol/fluticasone twice daily. CONCLUSION: Budesonide/formoterol for maintenance and relief is significantly more effective at reducing severe exacerbations than higher-dose ICS alone, or in combination with a LABA. This has important implications for treating uncontrolled patients at steps 2 and 3 of the joint BTS/SIGN guidelines.
OBJECTIVES: To compare the effectiveness of budesonide/formoterol (Symbicort) for Maintenance and Reliever Therapy (Symbicort SMART) Turbuhaler with twice daily inhaled corticosteroid (ICS) treatment, alone or in combination with a long-acting beta(2)-agonist (LABA). METHODS: Meta analysis of randomised controlled trials (RCTs) using a fixed effects model. RCTs were included if the comparator with budesonide/formoterol for maintenance and relief had the equivalent, or up to fourfold higher, maintenance dose of ICS. The primary outcome was the incidence of severe exacerbation (oral glucocorticosteroid treatment for > or = 3 days, emergency visit and/or hospitalisation). RESULTS: Of the seven RCTs available six met the inclusion criteria. Risk of severe exacerbations was significantly reduced: 41% vs. higher-dose budesonide alone [relative risk (RR) 0.59, 95% confidence interval (95% CI): 0.51-0.68, p < 0.00001]; 43% vs. equivalent dose budesonide/formoterol as maintenance twice daily (RR 0.57, 95% CI: 0.49-0.66, p < 0.00001); 24% vs. higher-dose salmeterol/fluticasone twice daily (RR 0.76, 95% CI: 0.64-0.90, p = 0.002); and 26% vs. higher-dose budesonide/formoterol twice daily (RR 0.74, 95% CI: 0.58-0.96, p = 0.02). Significant heterogeneity was not detected in the primary analyses (p > 0.1). Secondary analyses also demonstrated that budesonide/formoterol for maintenance and relief reduced the most severe exacerbations, resulting in less hospitalisations/accident and emergency visits than higher-dose budesonide, equivalent dose budesonide/formoterol and higher-dose salmeterol/fluticasone twice daily. CONCLUSION:Budesonide/formoterol for maintenance and relief is significantly more effective at reducing severe exacerbations than higher-dose ICS alone, or in combination with a LABA. This has important implications for treating uncontrolled patients at steps 2 and 3 of the joint BTS/SIGN guidelines.
Authors: M Diane Lougheed; Catherine Lemiere; Francine M Ducharme; Chris Licskai; Sharon D Dell; Brian H Rowe; Mark Fitzgerald; Richard Leigh; Wade Watson; Louis-Philippe Boulet Journal: Can Respir J Date: 2012 Mar-Apr Impact factor: 2.409
Authors: Elliot Israel; Juan Carlos Cardet; Jennifer K Carroll; Anne L Fuhlbrigge; Wilson D Pace; Nancy E Maher; Lilin She; Frank W Rockhold; Maureen Fagan; Victoria E Forth; Paulina Arias Hernandez; Brian K Manning; Jacqueline Rodriguez-Louis; Joel B Shields; Tamera Coyne-Beasley; Barbara M Kaplan; Cynthia S Rand; Wilfredo Morales-Cosme; Michael E Wechsler; Juan P Wisnivesky; Mary White; Barbara P Yawn; M Diane McKee; Paula J Busse; David C Kaelber; Sylvette Nazario; Michelle L Hernandez; Andrea J Apter; Ku-Lang Chang; Victor Pinto-Plata; Paul M Stranges; Laura P Hurley; Jennifer Trevor; Thomas B Casale; Geoffrey Chupp; Isaretta L Riley; Kartik Shenoy; Magdalena Pasarica; Rafael A Calderon-Candelario; Hazel Tapp; Ahmet Baydur Journal: Contemp Clin Trials Date: 2020-12-11 Impact factor: 2.226
Authors: Rik J B Loymans; Armin Gemperli; Judith Cohen; Sidney M Rubinstein; Peter J Sterk; Helen K Reddel; Peter Jüni; Gerben ter Riet Journal: BMJ Date: 2014-05-13