Triple therapy in uncontrolled asthma: a network meta-analysis of phase III studies.
Rogliani PaolaBeatrice Ludovica RitondoLuigino CalzettaPublished in: The European respiratory journal (2021)
Conflicting evidence is currently available concerning the impact on asthma exacerbation of triple inhaled corticosteroid (ICS)/long-acting β2-adrenoceptor agonist (LABA)/long-acting muscarinic receptor antagonist (LAMA) fixed-dose combination (FDC).Since meta-analyses allow settling controversies of apparently inconsistent results, we performed a network meta-analysis of phase III randomised controlled trials including 9535 patients to assess the effect of ICS/LABA/LAMA combinations in uncontrolled asthma.Triple combination therapies with an ICS administered at high dose (HD) were more effective (p<0.05) than medium-dose (MD) ICS/LABA/LAMA FDC and both MD and HD ICS/LABA FDCs against moderate to severe exacerbation (relative risk 0.61-0.80) and increasing trough forced expiratory volume in 1 s (from +33 to +114 mL). Triple combination therapies including HD ICS were superior (p<0.05) to MD ICS/LABA/LAMA FDC in preventing severe exacerbation (relative risk 0.46-0.65), but not with respect to moderate exacerbation (p>0.05). Triple combination therapies were equally effective on asthma control, with no safety concerns.This quantitative synthesis suggests that ICS/LABA/LAMA FDCs are effective and safe in uncontrolled asthma, and that the dose of ICS in the combination represents the discriminating factor to treat patients with a history of moderate or severe exacerbation.
Keyphrases
- chronic obstructive pulmonary disease
- phase iii
- lung function
- muscular dystrophy
- open label
- high dose
- clinical trial
- allergic rhinitis
- end stage renal disease
- early onset
- systematic review
- cystic fibrosis
- high intensity
- molecular dynamics
- chronic kidney disease
- low dose
- meta analyses
- ejection fraction
- drug induced
- patient reported outcomes
- mesenchymal stem cells
- duchenne muscular dystrophy