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Clinician Article

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Efficacy and safety of long-acting beta-agonist/long-acting muscarinic antagonist combinations in COPD: a network meta-analysis.

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• Oba Y
• Sarva ST
• Dias S

Read abstract Read evidence summary

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Clinical Comments

Family Medicine (FM)/General Practice (GP)

Network meta-analysis. Combination therapy looks good but there are still many unanswered questions about type of patients who may benefit from the combination, duration of therapy, longer-term adverse effects, etc.

Family Medicine (FM)/General Practice (GP)

Combining a long-acting muscarinic agent (LAMA) with a long-acting bronchodilator agent (LABA) provides an incremental benefit over use of a LAMA alone or a LABA alone for COPD. The differences are not huge, so it seems to me that one should probably choose single-agent LAMA as first-line inhaled pharmacotherapy for COPD. If a patient is still significantly symptomatic, consider a LAMA/LABA combination instead of changing to a LABA, or start with a LABA, then try a LAMA/LABA if that does not work adequately. But exacerbations still occur and the change in St George`s Respiratory Questionnaire scores are small and not significantly different when LAMA/LABA is compared with LAMA alone or even LABA alone, so don`t expect miracles.

General Internal Medicine-Primary Care(US)

I'm not sure that this is "news" to COPD providers.

General Internal Medicine-Primary Care(US)

This is useful information to primary care providers who see patients with COPD. It is good to know that the combination meds have similar safety profiles to each of their component meds and do have a bit higher efficacy.

Respirology/Pulmonology

Meta-analysis including 23 studies and more then 25,000 patients found that LABA/LAMA combination was superior to LABA or LAMA alone in bettering FEV1, dyspnea, and QOL. LABA/LAMA also decreased exacerbation rate compared to LABA alone. Just as significant was the lack of an increase in adverse events. These new inhalers will likely become key in treating moderate to severe COPD. Where inhaled corticosteroids fit with this new combination remains to be determined.

Respirology/Pulmonology

Network meta-analysis finding that dual LABA/LAMA bronchodilator therapy was better than monotherapy for improving lung function, symptoms and quality of life, but not for reducing severe exacerbations in patients with moderate to severe exacerbations. Differences between dual therapy and monotherapy were of limited magnitude, however, and not always clinically meaningful. Shows that the most potent treatment has the greatest effect, but it doesn't mean that all COPD patients need it. Nevertheless, it provides stronger validation for guideline recommendations to use dual bronchodilator therapy in patient who are more dyspneic or have lower lung function.