Prescribing bronchodilators for patients with chronic obstructive pulmonary disease (COPD) with varying levels of disease severity can be a difficult task for clinicians and healthcare professionals. Of late, several combinations of bronchodilators were approved for patient use in COPD and other respiratory diseases. In a recent article entitled “Comparative efficacy of combination bronchodilator therapies in COPD: a network meta-analysis” and published in the International Journal of Chronic Obstructive Pulmonary Disease, researchers assessed the comparative efficacy of new bronchodilator combinations over other bronchodilator options in a network meta-analysis (NMA) that tested umeclidinium and vilanterol (UMEC/VI) against other dual bronchodilators available as inhalable formulations.
A systematic literature review was conducted for the study, with randomized controlled trials of minimum 10 weeks duration with patients aged 40 years and above and with varying severities of COPD. A total of 77 articles covering up to 26 clinical trials were reviewed, and the comparison was conducted between existing doses of UMEC/VI, against indacaterol/glycopyrronium (QVA149), formoterol plus tiotropium (TIO), salmeterol plus TIO, or indacaterol plus TIO, with TIO and placebo as common comparators (all at standard prescribed doses) at 12 weeks and approximately 24 weeks. The parameters in the study compared baseline changes in trough forced expiratory volume in 1 second (FEV1), the total scores from the St. George’s Respiratory Questionnaire (SGRQ), focal scores from the transitional dyspnea index (TDI), and rescue medication use at 12 weeks and 24 weeks using an NMA within a Bayesian framework.
The results of this NMA showed that efficacy of UMEC/VI was not significantly different compared with QVA149 on trough FEV1,SGRQ total score, TDI focal score and rescue medication use. Even when compared against salmeterol plus TIO on trough FEV1, SGRQ total score, and TDI focal score and against formoterol plus TIO 18 µg on SGRQ total score, not much of statistically significant difference was observed. Lack of evidence prevented comparison against formoterol plus TIO on FEV1 or TDI at 24 weeks. The rest of the results were consistent at the end of 12 and 24 weeks.
These findings showed that the efficacy of most available bronchodilators in combination were more or less similar, without any significant differences. The findings offer new insights into the use of bronchodilators and how attending physicians can optimize treatment options for their COPD patients.
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