The quality of evidence is moderate (downgraded due to indirectness and imprecision). The evidence is applicable in Finland. An increased risk of pneumonia is a potentially serious adverse effect. Cost outcomes were not reported in the appraised study.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias «Additional comments for included studies...»2 |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis; COPD= chronic obstructive pulmonary disease, ICS=inhaled corticosteroids; LABA= long‐acting bronchodilators including beta2-agonists, LAMA= muscarinic antagonists, SGRQ= St George's Respiratory Questionnaire | |||||
| «van Geffen WH, Tan DJ, Walters JA, ym. Inhaled cor...»1 | SR and MA of RCTs (4 trials, n=15,412) | Adults with symptomatic COPD (mean age 64.4 to 65.3 years), symptomatic COPD (COPD Assessment Test Score ≥ 10), mostly severe–very severe airflow limitation (FEV1 <50%) and ≥1 exacerbation in previous year | Intervention: Triple inhaled therapy (ICS + LABA + LAMA) Comparison: Dual bronchodilation (LABA + LAMA) |
|
Overall low risk of bias; some concerns for attrition and reporting bias in individual studies |
| Reference | Comments |
|---|---|
| «van Geffen WH, Tan DJ, Walters JA, ym. Inhaled cor...»1 | Acute exacerbations of COPD were defined as "an acute worsening of COPD symptoms above
normal day-to-day variation" in all four studies. Severity was rated according to
the level of treatment: mild (shortacting bronchodilators), moderate (systemic glucocorticoids
or antibiotics), or severe (hospitalisation or death, or both). Across the four included studies, there were important differences in inclusion criteria, trial medications, and duration of follow-up. Investigation of heterogeneity was limited due to the small number of included studies. |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval; OR=odds ratio | |||||
| «van Geffen WH, Tan DJ, Walters JA, ym. Inhaled cor...»1 | 3 and 14,070 (9136/4934) | 52 weeks | 3878/9136 (42.4%) | 1741/4934 (35.3%) | OR 1.35, 95% CI 1.26 to 1.45. Translates to 71 more responders per 1000 treated with triple therapy (CI 54 more to 89 more). |
| Level of evidence: high | |||||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval; RR=risk ratio | |||||
| «van Geffen WH, Tan DJ, Walters JA, ym. Inhaled cor...»1 | 4 and 15,397 (9812 / 5585) | 52 weeks | Mean rate ranged from 0.46 to 1.08 exacerbations per year. | Mean rate ranged from 0.59 to 1.42 exacerbations per year. | RR 0.74 (95% CI 0.67–0.81) |
| Level of evidence: moderate/low The quality of evidence is downgraded due to indirectness. |
|||||
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval; OR=odds ratio | |||||
| «van Geffen WH, Tan DJ, Walters JA, ym. Inhaled cor...»1 | 4 and 15,397 (9812/5585) | 52 weeks | 139/9812 (1.4%) | 112/5585 (2.0%) | OR 0.70 (0.54 to 0.90); Translates to 6 fewer deaths per 1000 treated with triple therapy (9 fewer to 2 fewer) |
| Level of evidence: moderate The quality of evidence is downgraded due to indirectness and imprecision. |
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