Efficacy and safety of LABA/LAMA versus LABA/ICS for treatment of instable chronic obstructive pulmonary disease: a meta-analysis

Objective To compare the efficacy and safety of long-actingbeta-agonist/long-acting muscarinic antagonist (LABA/LAMA) versus long-actingbeta-agonist/inhaled corticosteroid (LABA/ICS) for treatment of stable chronic obstructive pulmonary disease (COPD). Methods Comprehensive searches were performed of the PubMed, Embase, Cochrane Library, Ovid, Wanfang and Chinese journal full-text database to acquire RCTs comparing LABA/LAMA treatment with LABA/ICS and duration of study >4 weeks.Two authors independently extracted data and assessed the methodological quality of the included studys following the preferred reporting items for systematic reviews and meta-analyses guidelines.Statistical analysis on the data was performed by RevMan 5.3 software and a subgroup analysis wasperformed by different LABA/LAMA combinations. Results Totally nine studies (ten RCTs) were included in the meta-analysis.Pooled analysis showed that compared to the LABA/ICS combinations, LABA/LAMA combinations significantly improved forced expiratory volume in one second (FEV1)(MD 0.09L, 95%CI: 0.08-0.11, P<0.000 01), reduced risk of exacerbation (OR=0.78, 95%CI: 0.64-0.94, P=0.01) and risk ofpneumonia (OR=0.59, 95%CI: 0.43-0.81, P=0.001) dramatically.The improvement of St George′s Respiratory Questionnaire scores was not different for LABA/LAMA versus LABA/ICS treatment(MD -0.66, 95%CI: -1.36-0.04, P=0.07), and the severe adverse event incidence between LABA/LAMA and LABA/ICS was similar (OR=0.89, 95%CI: 0.77-1.04, P=0.14). Conclusions Compared to the LABA/ICS combinations, LABA/LAMA combinationshad an advantage in the treatment of stable COPD in improving lung function, reducing acute exacerbation risk and reducing the risk of pneumonia. Key words: Long actingbeta agonist; Long acting muscarinic antagonist; Inhaled corticosteroid; Chronic obstructive pulmonary disease; Meta-analysis