Association of Inhaled Corticosteroids and Long-Acting #Muscarinic Antagonists With Asthma Control in Patients With Uncontrolled, Persistent #Asthma
https://jamanetwork.com/journals/jama/fullarticle/2675736
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
https://jamanetwork.com/journals/jama/fullarticle/2675736
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