Efficacy of ICS versus Non-ICS Combination Therapy in COPD: A Meta-Analysis of Randomised Controlled Trials

Abstract

Background

Several large randomized clinical trials (RCTs) have assessed the efficacy and safety of inhaled corticosteroid (ICS) combination regimens versus non-ICS therapy in patients with chronic obstructive pulmonary disease (COPD) at increased risk of exacerbation risk with mixed results.

Methods

We performed a systematic literature review and meta-analysis of RCTs comparing the effect of ICS-containing combination therapy and non-ICS regimen in patients with COPD.

Results

A total of 54 RCTs (N = 57,333) reported treatment effects on various outcomes and were eligible for inclusion. Overall, the number of patients experiencing moderate/severe exacerbations was significantly lower for ICS-containing combination therapy versus non-ICS therapy (RR: 0.86 [95% CI: 0.80–0.93]). The annual rate of exacerbations was also significantly reduced by 22% (0.78 [0.72–0.86]) with ICS-containing versus non-ICS therapy. The annual rate of exacerbations requiring hospitalisation was reduced by 31% versus non-ICS therapy (0.69 [0.54–0.88]); similar reduction was observed for exacerbations requiring oral steroids (0.69 [0.66–0.73]). Overall, the effect on trough FEV1 was comparable between ICS-containing and non-ICS therapies (follow-up: 6–52 weeks); however, a significant improvement in lung function (trough FEV1) was observed for ICS/LABA versus LABA (MD: +0.04 L [0.03−0.05]) and ICS/LABA/LAMA versus LAMA (MD: +0.09 L [0.05−0.13]) regimens. In addition, a significant improvement in QoL was observed with ICS-containing versus non-ICS therapy (MD in SGRQ score: −0.90 [−1.50, −0.31]).

Conclusion

This meta-analysis demonstrated that a wide range of patients with COPD could benefit from dual and triple ICS-containing therapy.

Keywords:

• meta-analysis
• chronic obstructive pulmonary disease
• inhaled corticosteroid
• dual therapy
• triple therapy
• exacerbation

Data Sharing Statement

The datasets used and/or analysed during the current study are available from Yahong Chen ([email protected]) on reasonable request.

Acknowledgments

Editorial assistance was provided by Syed Abdul Haseeb and Julia Ventura from MediTech Media (Singapore), which was funded by AstraZeneca China in accordance with Good Publication Practice (GPP3) guidelines.

Author Contributions

All authors had access to all relevant data. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. Yanling Ding and Lina Sun are co-first authors.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by AstraZeneca China.