Luigino Calzetta1, Josuel Ora2, Francesco Cavalli1, Paola Rogliani3, Denis E O'Donnell4, Mario Cazzola5. 1. Chair of Respiratory Medicine and Unit of Respiratory Clinical Pharmacology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. 2. Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy. 3. Chair of Respiratory Medicine and Unit of Respiratory Clinical Pharmacology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Division of Respiratory Medicine, University Hospital Tor Vergata, Rome, Italy. 4. Division of Respiratory Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada. 5. Chair of Respiratory Medicine and Unit of Respiratory Clinical Pharmacology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. Electronic address: mario.cazzola@uniroma2.it.
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 METHODS: RCTs were identified after a search in different databases of published and unpublished trials.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.
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.
Authors: Fabiano Di Marco; Giovanni Sotgiu; Pierachille Santus; Denis E O'Donnell; Kai-Michael Beeh; Simone Dore; Maria Adelaide Roggi; Lisa Giuliani; Francesco Blasi; Stefano Centanni Journal: Respir Res Date: 2018-01-24
Authors: Imran Satia; Mohammad Abdul Malik Farooqi; Ruth Cusack; Masanobu Matsuoka; Xie Yanqing; Om Kurmi; Paul M O'Byrne; Kieran J Killian Journal: Physiol Rep Date: 2020-04
Authors: Claudia C Dobler; Magdoleen H Farah; Allison S Morrow; Mouaz Alsawas; Raed Benkhadra; Bashar Hasan; Larry J Prokop; Zhen Wang; M Hassan Murad Journal: BMJ Open Date: 2019-05-05 Impact factor: 2.692