These findings are of direct relevance to clinical practice because we included all currently available LABA/LAMAs and comparators, only at doses approved for clinical use.ĬOPD LABA/ICS LABA/LAMA combinations LAMA meta-analysis.ĭisclosure GJR has participated as a lecturer, speaker and advisor in scientific meetings and courses under the sponsorship of Air Products and Chemicals Inc, Almirall, AstraZeneca, Boehringer Ingelheim, Laboratorios Dr Esteve, GlaxoSmithKline, Merck Sharp & Dome and Novartis. The greater efficacy and comparable safety profiles observed with LABA/LAMA combinations versus LAMA or LABA/ICS support their potential role as first-line treatment options in COPD. LABA/LAMA presented a lower risk for withdrawals due to lack of efficacy versus LAMA (RR: 0.66, 95% CI: ) and due to AEs versus LABA/ICS (RR: 0.83, 95% CI: ). Adverse event (AE) incidence was no different for LABA/LAMA versus LAMA treatment, but it was lower versus LABA/ICS (RR 0.94, 95% CI: ), including a lower pneumonia risk (RR 0.59, 95% CI: ). LABA/LAMA significantly reduced moderate/severe exacerbation rate compared with LABA/ICS (RR 0.82, 95% CI: ). LABA/LAMA improved transitional dyspnea index and St George's Respiratory Questionnaire scores at week 12 versus LAMA (both P<0.0001), but not versus LABA/ICS, and reduced rescue medication use versus both ( P<0.0001 and P=0.001, respectively). LABA/LAMA significantly improved trough forced expiratory volume in 1 second (FEV 1) from baseline to week 12 versus both LAMA and LABA/ICS (0.07 L and 0.08 L, P100 mL (risk ratio : 1.33, 95% confidence interval : and RR: 1.44, 95% CI:, respectively, the number needed to treat being eight and six, respectively). Eligible studies were independently selected by two authors using predefined data fields the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.Įighteen studies (23 trials) were eligible (N=20,185).

This systematic review and meta-analysis (PubMed/MEDLINE, Embase, Cochrane Library and clinical trial/manufacturer databases) included RCTs comparing ≥12 weeks' LABA/LAMA treatment with LAMA and/or LABA/ICS (approved doses only). The objective of this analysis was to compare the efficacy and safety of LABA/LAMA with LAMA or LABA/inhaled corticosteroid (ICS) in adults with stable moderate-to-very-severe COPD. Randomized controlled trials (RCTs) indicate that long-acting bronchodilator combinations, such as β 2-agonist (LABA)/muscarinic antagonist (LAMA), have favorable efficacy compared with commonly used COPD treatments.

Laba lama combinatio.s