Incremental long-term benefit of drug therapies for chronic obstructive pulmonary disease in quality of life but not mortality: a network meta-analysis.

IF 3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Archives of Medical Science Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI:10.5114/aoms/183025

Qiong Pan, Jiongzhou Sun, Shiyuan Gao, Zian Liu, Yiwen Huang, Yixin Lian

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引用次数: 0

Abstract

Introduction: The latest evidence revealed that dupilumab, an interleukin-4 (IL-4) and interleukin-13 (IL-13) blocker, significantly reduces the exacerbation risk in patients with chronic obstructive pulmonary disease (COPD). The efficacy of dupilumab compared with conventional inhaled drugs remains incompletely determined. This study aimed to investigate the comparative efficacy of dupilumab and conventional inhaled drugs in patients with stable COPD.

Material and methods: This study retrieved randomised clinical trials (RCTs) with follow-up ≥ 48 weeks on long-acting β-agonists (LABAs), long-acting muscarinic receptor antagonists (LAMAs), inhaled corticosteroids (ICSs), and dupilumab in the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases. The information on eligible studies was extracted after the screening. The comparative efficacy of 4 drugs and their combinations in acute exacerbation and mortality was assessed using Bayesian network meta-analysis models.

Results: This network meta-analysis identified 69 eligible RCTs on 7 classes of drug therapies after stepwise screening and included 125,331 COPD patients. Compared with placebo, the 7 drug interventions significantly reduced the risk of acute exacerbation, and the reduction degree increased with the incremental use of drug classes. ICS/LABA/LAMA/dupilumab was the most effective in decreasing exacerbation risk (OR = 0.561 [95% CI: 0.387-0.810]), followed by ICS/LABA/LAMA (OR = 0.717 [95% CI: 0.626-0.817]). The 7 drug therapies were not significantly associated with a lower risk of death compared to placebo. Nevertheless, ICS/LABA/LAMA/dupilumab is the most likely to be effective in decreasing mortality.

Conclusions: The incremental use of combinations of conventional and novel drugs contributed to the long-term benefits in acute exacerbation but not death in COPD. The optimal drug combination in terms of acute COPD exacerbation was ICS/LABA/LAMA/dupilumab.

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慢性阻塞性肺疾病药物治疗对生活质量而非死亡率的增量长期益处：一项网络荟萃分析

最新证据显示，白细胞介素-4 （IL-4）和白细胞介素-13 （IL-13）阻滞剂dupilumab可显著降低慢性阻塞性肺疾病（COPD）患者的恶化风险。与传统吸入药物相比，dupilumab的疗效尚未完全确定。本研究旨在探讨dupilumab与传统吸入药物在稳定期COPD患者中的比较疗效。材料和方法：本研究检索了PubMed、EMBASE和Cochrane Central Register of Controlled trials数据库中关于长效β激动剂（LABAs）、长效毒碱受体拮抗剂（LAMAs）、吸入皮质类固醇（ics）和杜匹单抗的随机临床试验（RCTs），随访≥48周。筛选后提取符合条件的研究信息。采用贝叶斯网络meta分析模型评价4种药物及其联合用药对急性加重和死亡率的比较疗效。结果：该网络荟萃分析在逐步筛选后确定了7类药物治疗的69项符合条件的随机对照试验，包括125,331名COPD患者。与安慰剂相比，7种药物干预均显著降低急性加重风险，且降低程度随药物种类的增加而增加。ICS/LABA/LAMA/dupilumab在降低恶化风险方面最有效（OR = 0.561 [95% CI: 0.387-0.810]），其次是ICS/LABA/LAMA （OR = 0.717 [95% CI: 0.626-0.817]）。与安慰剂相比，这7种药物治疗与较低的死亡风险没有显著相关。然而，ICS/LABA/LAMA/dupilumab在降低死亡率方面最有可能有效。结论：传统药物和新型药物联合使用的增加有助于慢性阻塞性肺病急性加重的长期获益，但没有导致死亡。急性COPD加重的最佳药物组合为ICS/LABA/LAMA/dupilumab。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of Medical Science 医学-医学：内科

CiteScore

4.90

自引率

7.90%

发文量

139

审稿时长

1.7 months

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