Association of Inhaled Corticosteroids and Long-Acting Muscarinic Antagonists With Asthma Control in Patients With Uncontrolled, Persistent Asthma A Systematic Review and Meta-analysis

editorial comment icon 
Editorial
Comment
related articles icon 
Related
Articles
 
Key Points

Question  What is the efficacy associated with long-acting muscarinic antagonists (LAMAs) as add-on therapy to inhaled corticosteroids in patients with uncontrolled, persistent asthma?

Findings  In this meta-analysis that included 15 randomized clinical trials with 7122 participants 12 years or older with uncontrolled, persistent asthma, LAMA vs placebo as an add-on therapy to inhaled corticosteroids was associated with a lower risk of exacerbations requiring systemic corticosteroids (risk difference, −1.8).

Meaning  LAMA use was associated with better clinical outcomes than placebo in patients with uncontrolled, persistent asthma.

Abstract

Importance  Long-acting muscarinic antagonists (LAMAs) are a potential adjunct therapy to inhaled corticosteroids in the management of persistent asthma.

Objective  To conduct a systematic review and meta-analysis of the effects associated with LAMA vs placebo or vs other controllers as an add-on therapy to inhaled corticosteroids and the use of a LAMA as add-on therapy to inhaled corticosteroids and long-acting β-agonists (LABAs; hereafter referred to as triple therapy) vs inhaled corticosteroids and LABA in patients with uncontrolled, persistent asthma.

Data Sources  MEDLINE, EMBASE, Cochrane databases, and clinical trial registries (earliest date through November 28, 2017).

Study Selection  Two reviewers selected randomized clinical trials or observational studies evaluating a LAMA vs placebo or vs another controller as an add-on therapy to inhaled corticosteroids or triple therapy vs inhaled corticosteroids and LABA in patients with uncontrolled, persistent asthma reporting on an outcome of interest.

Data Extraction and Synthesis  Meta-analyses using a random-effects model was conducted to calculate risk ratios (RRs), risk differences (RDs), and mean differences (MDs) with corresponding 95% CIs. Citation screening, data abstraction, risk assessment, and strength-of-evidence grading were completed by 2 independent reviewers.

Main Outcomes and Measures  Asthma exacerbations.

Results  Of 1326 records identified, 15 randomized clinical trials (N = 7122 patients) were included. Most trials assessed adding LAMA vs placebo or LAMA vs LABA to inhaled corticosteroids. Adding LAMA vs placebo to inhaled corticosteroids was associated with a significantly reduced risk of exacerbation requiring systemic corticosteroids (RR, 0.67 [95% CI, 0.48 to 0.92]; RD, −0.02 [95% CI, −0.04 to 0.00]). Compared with adding LABA, adding LAMA to inhaled corticosteroids was not associated with significant improvements in exacerbation risk (RR, 0.87 [95% CI, 0.53 to 1.42]; RD, 0.00 [95% CI, −0.02 to 0.02]), or any other outcomes of interest. Triple therapy was not significantly associated with improved exacerbation risk vs inhaled corticosteroids and LABA (RR, 0.84 [95% CI, 0.57 to 1.22]; RD, −0.01 [95% CI, −0.08 to 0.07]).

Conclusions and Relevance  In this systematic review and meta-analysis, the use of LAMA compared with placebo as add-on therapy to inhaled corticosteroids was associated with a lower risk of asthma exacerbations; however, the association of LAMA with benefit may not be greater than that with LABA. Triple therapy was not associated with a lower risk of exacerbations.

 to download free article PDFs, sign up for alerts, and more

(You must be logged in to add and reply comments)

Interasma on Twitter

Interasma RT @Aller_MD: Top tips on getting through hot weather with hay fever https://t.co/ab0jHLpZBM
1hreplyretweetfavorite
Interasma RT @Aller_MD: FDA investigating unauthorized herpes vaccine research https://t.co/47Tk96Bjpb
1hreplyretweetfavorite
Interasma RT @Aller_MD: Children with low-risk penicillin #allergy symptoms who tested negative for penicillin allergy tolerated penicillin without s…
1hreplyretweetfavorite
Interasma RT @Aller_MD: By assessing the industry- and occupation-specific prevalence of asthma, this report aims to assist physicians to identify wo…
6hreplyretweetfavorite
Interasma RT @Aller_MD: Although allergies might seem a world away from mental health, a new study finds that common allergic conditions increase the…
6hreplyretweetfavorite

Editor: Juan C. Ivancevich, MD

Copyright © Interasma 2003-2017  •  Terms of Use  •  Privacy Policy  •  Contact Us  •  Sitemap

Powered by FREI SA

InterAsma