![]() This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: The data are available by accessing the published studies listed in S3 Text. Received: FebruAccepted: OctoPublished: November 15, 2019Ĭopyright: © 2019 Lee et al. Shapiro, University of Pittsburgh, UNITED STATES ![]() PLoS Med 16(11):Īcademic Editor: Steven D. The main limitation is that there were few RCTs including only less symptomatic patients or patients at a low risk.Ĭitation: Lee HW, Park J, Jo J, Jang EJ, Lee C-H (2019) Comparisons of exacerbations and mortality among regular inhaled therapies for patients with stable chronic obstructive pulmonary disease: Systematic review and Bayesian network meta-analysis. ICS/LAMA/LABA increased the probability of pneumonia (OR for triple therapy = 1.56 95% CrI 1.19–2.03 P = 1.000). ICS/LAMA/LABA tended to lower the risk of cardiovascular mortality but did not show significant results. The results minimally changed, even in various sensitivity and covariate-adjusted meta-regression analyses. ICS/LAMA/LABA was the most efficacious treatment for reducing the exacerbation risk (odds ratio = 0.57 95% credible interval 0.50–0.64 posterior probability of OR > 1 1] = 0.004 and OR = 0.86, 95% CrI 0.76–0.98, P = 0.015, respectively). Compared with placebo, all drug classes significantly reduced the total exacerbations and moderate to severe exacerbations. In total, 219 trials involving 228,710 patients were included. This study was prospectively registered in International Prospective Register of Systematic Reviews (PROSPERO CRD42017069087). The eligibility criteria were as follows: (1) parallel-design randomized controlled trials (RCTs) (2) adults with stable COPD (3) comparisons among long-acting muscarinic antagonists (LAMAs), long-acting beta-agonists (LABAs), inhaled corticosteroids (ICSs), combined treatment (ICS/LAMA/LABA, LAMA/LABA, or ICS/LABA), or a placebo and (4) study duration ≥ 12 weeks. We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials,, the European Union Clinical Trials Register, and the official websites of pharmaceutical companies (from inception to July 9, 2019). We performed a systematic review (SR) and Bayesian network meta-analysis (NMA).
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