Background
Clinically important deterioration (CID) endpoint was developed in COPD to assess disease progression by detecting early deteriorations in lung function, health status, and exacerbations. However, no quantitative synthesis has been performed to investigate the efficacy of COPD treatments on CID.
Aim
To assess the impact on CID of pharmacological treatments of COPD.
Methods
A pairwise meta-analysis was carried out according to PRISMA-P to assess the efficacy of pharmacological treatments against CID in COPD patients. The search was performed in MEDLINE.
Results
Of the 235 records identified in the search, 22 studies were deemed eligible for meta-analysis and included 58,292 COPD patients. Generally, CID was defined according to FEV1, exacerbations, SGRQ, and CAT. Overall, the pharmacological treatment of COPD significantly reduced the risk of CID (RR 0.81 95%CI 0.79?0.84). The impact on CID was treatment related, with detailed comparisons resulting as follows: LABA vs. PCB (RR 0.82 95%CI 0.78?0.86), LAMA vs. PCB (RR 0.78 95%CI 0.69?0.88), LABA/LAMA vs. PCB (RR 0.67 95%CI 0.60?0.76), LAMA vs. LABA (RR 0.93 95%CI 0.86?0.98), ICS/LABA vs. LABA (RR 0.90 95%CI 0.86?0.93), LABA/LAMA vs. LABA (RR 0.81 95%CI 0.75?0.87), LABA/LAMA vs. LAMA (RR 0.85 95%CI 0.82?0.88), LABA/LAMA vs. ICS/LABA (RR 0.82 95%CI 0.75?0.91), ICS/LABA/LAMA vs. LAMA (RR 0.90 95%CI 0.86?0.94), ICS/LABA/LAMA vs. ICS/LABA (RR 0.74 95%CI 0.65?0.85), ICS/LABA/LAMA vs. LABA/LAMA (RR 0.94 95%CI 0.90?0.98).
Conclusions
Pharmacological treatments of COPD have a beneficial impact against CID when compared to PCB. When compared to active treatments, LABA/LAMA and ICS/LABA/LAMA resulted the most effective combinations in reducing the risk of CID.