https://orcid.org/0000-0003-0314-2859
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Abstract
Background/objective
To compare the efficacy of budesonide/formoterol (BF) versus fluticasone/salmeterol (FS) in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD).
Methods
The PubMed, Embase, Cochrane Library, and Web of Science databases were searched for studies comparing BF versus FS in the treatment of COPD from inception to July 17, 2023. Outcomes, including exacerbations, hospitalizations, pneumonia, emergency department (ED) visits for COPD, length of hospitalization, and number of exacerbations, were compared using risk ratio (RR) with corresponding 95% confidence interval (CI) or weighted mean difference (WMD) with 95% CI. All statistical analyses were performed using Stata version 12.0.
Results
Ten studies comprising a total of 136,369 participants were included. Compared with those treated with FS, patients with COPD treated with BF experienced a reduced number of exacerbations (RR 0.91 [95% CI 0.83–1.00]; p = 0.040), hospitalizations (RR 0.77 [95% CI 0.67–0.88]; p < 0.001), and frequency of pneumonia (RR 0.77 [95% CI 0.64–0.92]; p = 0.05). However, no significant difference was observed between BF and FS in terms of ED visits for COPD (RR 0.87 [95% CI 0.69–1.10]; p = 0.243), length of hospitalization (WMD −0.18 [95% CI −0.62–0.27]; p = 0.437), and number of exacerbations (WMD −0.06 [95% CI −0.28–0.16]; p = 0.602). Notably, no significant heterogeneity was noted in length of hospitalization between the two groups, whereas clear heterogeneity was observed in other outcomes (I2 > 50%, p < 0.05).
Conclusion
Compared with FS, BF therapy appears to be a more promising treatment strategy for patients with moderate-to-severe COPD; however, this should be verified in further high-quality studies.
Authors’ contributions
Yueping Jin designed the study. Nan Shang and Yang Liu performed literature searching and collected the literature. Nan Shang performed the statistical analysis. Nan Shang was a major contributor in writing the manuscript. All authors read and approved the final manuscript.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
The data analyzed in this study was available from the corresponding author upon reasonable request.