All-Cause and Cardiovascular Mortality With Single Inhaler Triple Therapy Versus Double Therapies for COPD: A Systematic Review and Metanalysis.

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia Pub Date : 2025-02-21 DOI:10.1016/j.arbres.2025.02.004

Ayoub Hammadi, Clara Hoyas-Sánchez, Alejandro Romero-Linares, Lucia Álvarez-Muro, Antonio Menéndez-Lobo, Damaris Romeral-Navarro, Andrea Jiménez-Antón, Angel Almansa-López, Laura Casares-Martin-Moreno, Esther Sánchez-Álvarez, Pedro Jose Romero-Palacios, Bernardino Alcázar-Navarrete

{"title":"All-Cause and Cardiovascular Mortality With Single Inhaler Triple Therapy Versus Double Therapies for COPD: A Systematic Review and Metanalysis.","authors":"Ayoub Hammadi, Clara Hoyas-Sánchez, Alejandro Romero-Linares, Lucia Álvarez-Muro, Antonio Menéndez-Lobo, Damaris Romeral-Navarro, Andrea Jiménez-Antón, Angel Almansa-López, Laura Casares-Martin-Moreno, Esther Sánchez-Álvarez, Pedro Jose Romero-Palacios, Bernardino Alcázar-Navarrete","doi":"10.1016/j.arbres.2025.02.004","DOIUrl":null,"url":null,"abstract":"Introduction: COPD is a major public health concern, often complicated by cardiovascular comorbidities. Single inhaler triple therapy (SITT) has been proposed as a superior treatment option compared to single inhaler double therapies (SIDT) as LABA/LAMA and LABA/ICS. This systematic review and meta-analysis aim to evaluate the comparative efficacy of these therapies in reducing cardiovascular mortality, major adverse cardiovascular events (MACEs), and all-cause mortality (ACM).Methods: We conducted a systematic review and metanalysis including RCT studies comparing SITT with LABA/LAMA or LABA/ICS with mortality as efficacy or safety endpoints. Articles were selected after reviewing PubMed, SCOPUS, Embase, Scielo and clinicaltrials.gov and clinicaltrialsregister.eu from May'24 to Jul'24. Random-effects models were used to estimate the pooled odds ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular mortality, MACEs, and ACM. Heterogeneity and publication bias were assessed using standard statistical methods.Results: The systematic review yielded 568 studies of which 11 were finally included, with 25,774 COPD patients. SITT was superior to LABA/LAMA on ACM (pooled HR 0.727; 95% CI 0.574-0.921, p=0.008) and cardiovascular mortality (pooled HR 0.455; 95% CI 0.292-0.710, p<0.001), with no effect on MACEs. SITT showed no difference versus LABA/ICS on ACM, cardiovascular mortality or MACEs.Conclusions: SITT significantly reduces cardiovascular and all-cause mortality compared to LABA/LAMA. Compared to LABA/ICS, SITT does not show a significant difference.Prospero identifier: CRD42024510253.","PeriodicalId":8339,"journal":{"name":"Archivos De Bronconeumologia","volume":" ","pages":""},"PeriodicalIF":8.7000,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archivos De Bronconeumologia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arbres.2025.02.004","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: COPD is a major public health concern, often complicated by cardiovascular comorbidities. Single inhaler triple therapy (SITT) has been proposed as a superior treatment option compared to single inhaler double therapies (SIDT) as LABA/LAMA and LABA/ICS. This systematic review and meta-analysis aim to evaluate the comparative efficacy of these therapies in reducing cardiovascular mortality, major adverse cardiovascular events (MACEs), and all-cause mortality (ACM).

Methods: We conducted a systematic review and metanalysis including RCT studies comparing SITT with LABA/LAMA or LABA/ICS with mortality as efficacy or safety endpoints. Articles were selected after reviewing PubMed, SCOPUS, Embase, Scielo and clinicaltrials.gov and clinicaltrialsregister.eu from May'24 to Jul'24. Random-effects models were used to estimate the pooled odds ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular mortality, MACEs, and ACM. Heterogeneity and publication bias were assessed using standard statistical methods.

Results: The systematic review yielded 568 studies of which 11 were finally included, with 25,774 COPD patients. SITT was superior to LABA/LAMA on ACM (pooled HR 0.727; 95% CI 0.574-0.921, p=0.008) and cardiovascular mortality (pooled HR 0.455; 95% CI 0.292-0.710, p<0.001), with no effect on MACEs. SITT showed no difference versus LABA/ICS on ACM, cardiovascular mortality or MACEs.

Conclusions: SITT significantly reduces cardiovascular and all-cause mortality compared to LABA/LAMA. Compared to LABA/ICS, SITT does not show a significant difference.

Prospero identifier: CRD42024510253.

查看原文本刊更多论文

慢性阻塞性肺病单吸入器三联治疗与双联治疗的全因死亡率和心血管死亡率：系统回顾和荟萃分析

慢性阻塞性肺病是一个主要的公共卫生问题，常伴有心血管合并症。与LABA/LAMA和LABA/ICS等单吸入器双治疗（SIDT）相比，单吸入器三联治疗（SITT）被认为是一种更好的治疗选择。本系统综述和荟萃分析旨在评估这些疗法在降低心血管死亡率、主要不良心血管事件（mace）和全因死亡率（ACM）方面的比较疗效。方法：我们进行了系统回顾和荟萃分析，包括以死亡率为疗效或安全性终点，比较SITT与LABA/LAMA或LABA/ICS的RCT研究。文章经过PubMed、SCOPUS、Embase、Scielo和clinicaltrials.gov和clinicaltrialsregister的筛选。从5月24日到7月24日。随机效应模型用于估计心血管死亡率、mace和ACM的合并优势比（hr）和95%置信区间（ci）。采用标准统计方法评估异质性和发表偏倚。结果：系统评价共纳入568项研究，其中11项最终纳入，共纳入25,774例COPD患者。SITT在ACM上优于LABA/LAMA(合并HR为0.727；95% CI 0.574-0.921, p=0.008)和心血管死亡率(总危险度0.455；结论：与LABA/LAMA相比，SITT可显著降低心血管和全因死亡率。与LABA/ICS相比，SITT无显著差异。普洛斯彼罗标识符：CRD42024510253。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Archivos De Bronconeumologia Medicine-Pulmonary and Respiratory Medicine

CiteScore

3.50

自引率

17.50%

发文量

330

审稿时长

14 days

期刊介绍： Archivos de Bronconeumologia is a scientific journal that specializes in publishing prospective original research articles focusing on various aspects of respiratory diseases, including epidemiology, pathophysiology, clinical practice, surgery, and basic investigation. Additionally, the journal features other types of articles such as reviews, editorials, special articles of interest to the society and editorial board, scientific letters, letters to the editor, and clinical images. Published monthly, the journal comprises 12 regular issues along with occasional supplements containing articles from different sections. All manuscripts submitted to the journal undergo rigorous evaluation by the editors and are subjected to expert peer review. The editorial team, led by the Editor and/or an Associate Editor, manages the peer-review process. Archivos de Bronconeumologia is published monthly in English, facilitating broad dissemination of the latest research findings in the field.