Chest
Original ResearchCOPDSafety and Efficacy of Combined Long-Acting β-Agonists and Inhaled Corticosteroids vs Long-Acting β-Agonists Monotherapy for Stable COPD: A Systematic Review
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Search Strategy and Selection Criteria
We identified studies from MEDLINE, EMBASE (January 1980 to May 2009), and the Cochrane Controlled Trials Register (second quarter of 2009) databases by using the following MeSH, full text, and keywords terms: (long-acting β2 adrenoceptor agonist OR salmeterol OR formoterol OR inhaled corticosteroids OR fluticasone OR budesonide OR beclomethasone) AND (COPD OR chronic bronchitis OR emphysema). Also, we performed a search of relevant files from AstraZeneca (www.astrazenecaclinicaltrials.com) and
Results
Of 164 potential relevant citations, 18 randomized, controlled trials14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 fulfilled the inclusion criteria (Fig 1). Five trials were unpublished.27, 28, 29, 30, 31 Data analysis was restricted to the LABAs/ICSs and LABAs arms of those trials (12,446 patients) [Table 1]. Five studies used formoterol/budesonide combination therapy,17, 20, 26, 27 and 13 studies used salmeterol/fluticasone combination therapy.14, 15, 16, 18, 19, 21,
Discussion
In the present study, which is the largest systematic review designed to evaluate the safety and efficacy of the regular use of LABAs/ICSs compared with the use of LABAs alone in stable patients with moderate-to-very severe COPD, we found that treatment with LABAs/ICSs did not modify the risks of overall mortality, respiratory deaths, and cardiovascular mortality (primary outcomes) compared with treatment with LABAs alone. On the contrary, the analysis of secondary outcomes showed that therapy
Acknowledgments
Author contributions: Dr. Rodrigo (1) has made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; (2) has drafted the submitted article and revised it critically for important intellectual content; and (3) has provided final approval of the version of the article to be published. Dr. Castro-Rodriguez (1) has made substantial contributions to conception and design, and interpretation of data; (2) has revised the article critically
References (0)
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Funding/Support: The funding for this study came from salary support for Dr. Rodrigo. No sponsorship from institutions or pharmaceutical industry was provided to conduct this study.
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