Comparison of Clinical Efficacy and Safety between ultraLABAs and ultraLAMAs in Patients with COPD: A Systemic Review with a Meta-Analysis of Randomized Controlled Trials

Abstract

Background: A single long-acting bronchodilator, ultra-long acting muscarinic antagonist (ultra-LAMA) or ultra-long acting β2-agonist (ultra-LABA) is preferred for the initial treatment of patients with chronic obstructive pulmonary disease (COPD); however, there are few head-to-head comparative studies between the two. Here, a meta-analysis of randomized controlled trials was performed to compare the clinical efficacy and safety of ultra-LABA and ultra-LAMA in patients with moderate-to-severe COPD.

Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched (to March 1, 2017) to identify all published randomized controlled trials.

Results: Of the 12,906 articles found by searching the databases, we obtained data from 10,591 patients with COPD (LABA, n = 5,058; LAMA, n = 5,533) in seven published studies. Our results show that worsening of COPD was higher for patients taking ultra-LABA than for those taking ultra-LAMA (odds ratio = 1.162, P = 0.0012). However, no significant differences were observed between ultra-LAMA and ultra-LABA patients regarding improvement in trough forced expiratory volume in 1 s, the transitional dyspnea index, or St. George’s Respiratory Questionnaire score.

Conclusion: This study suggests that worsening of COPD occurred more often in patients taking an ultra-LABA than in those taking an ultra-LAMA with similar efficacy of lung function and quality of life.