Comparison of three combined pharmacological approaches with tiotropium monotherapy in stable moderate to severe COPD: A systematic review

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dc.contributor.authorRodrigo, Gustavo J.
dc.contributor.authorPlaza, Vicente
dc.contributor.authorCastro Rodríguez, José Antonio
dc.date.accessioned2021-11-30T18:40:34Z
dc.date.available2021-11-30T18:40:34Z
dc.date.issued2012
dc.description.abstractBackground: Guidelines recommend the use of inhaled long-acting bronchodilators, inhaled corticosteroids (ICS) and their combinations for maintenance treatment of moderate to severe COPD. However, there are limited data supporting combination therapy. Methods: This systematic review assessed the efficacy of three therapeutic approaches: tiotropium plus long-acting beta2-agonist (LABA) (“dual” therapy), LABA/ICS (“combined” therapy), and tiotropium plus LABA/ICS (“triple” therapy), all compared with tiotropium monotherapy. Randomized controlled trials were identified after a search of different databases of published and unpublished trials. Results: Twenty trials (6803 participants) were included. “Dual” therapy showed significant improvements in forced volume in the first second (FEV1), health-related quality of life (HRQoL), and dyspnea. However, it failed to reduce the risk of COPD exacerbations. Compared with tiotropium, “combined” therapy presented modest but significant effects on FEV1, HRQoL, and dyspnea. Again, there was no significant difference in exacerbations, but it was associated with a significant increase of serious adverse effects (SAE) (number need to treat for harm [NNTH] ¼ 20; 95% CI: 11e119). Finally, “triple therapy” increased FEV1, improved HRQoL (both benefits exceeded minimal important differences) and decrease COPD exacerbations in anon-significant way. (Odds ratio [OR] ¼ 0.57; 95% CI: 0.24 to 1.37, p ¼ 0.21). Conclusions: “Dual” and “triple” therapy seem like the most promising for patients with moderate to very severe COPD. However, data are still scarce and studies too short to generate a strong recommendation. Future studies should examine long-term efficacy and safety.
dc.fuente.origenORCID
dc.identifier.doi10.1016/j.pupt.2011.10.006
dc.identifier.issn1094-5539
dc.identifier.urihttps://www.doi.org/10.1016/j.pupt.2011.10.006
dc.identifier.urihttp://www.scopus.com/inward/record.url?eid=2-s2.0-84856785850&partnerID=MN8TOARS
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/62986
dc.information.autorucEscuela de medicina ; Castro Rodríguez, José Antonio ; 0000-0002-0708-4281 ; 113247
dc.issue.numeroNo. 1
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final47
dc.pagina.inicio40
dc.provenancengjara 2021-11-30 15:40:33
dc.relation.isformatofPulmonary Pharmacology & Therapeutics, vol. 25, no. 1 (feb. 2012), pp. 40-47.
dc.revistaPulmonary Pharmacology & Therapeutics
dc.rightsacceso abierto
dc.subjectLong-acting beta2-agonists
dc.subjectLong-acting muscarinic antagonists
dc.subjectCOPD
dc.subjectTherapy
dc.subjectInhaled corticosteroids
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.otherMedicina y salud
dc.titleComparison of three combined pharmacological approaches with tiotropium monotherapy in stable moderate to severe COPD: A systematic review
dc.typeartículo
dc.volumenVol. 25
sipa.codpersvinculados113247
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