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首页> 外文期刊>Pulmonary therapy. >Triple Therapy Versus Dual Bronchodilation and Inhaled Corticosteroids/Long-Acting β-Agonists in COPD: Accumulating Evidence from Network Meta-Analyses
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Triple Therapy Versus Dual Bronchodilation and Inhaled Corticosteroids/Long-Acting β-Agonists in COPD: Accumulating Evidence from Network Meta-Analyses

机译：Triple治疗与双支气管扩张和吸入皮质类固醇/长效β-激动剂在COPD中：从网络META分析中累积证据

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Guidelines are mainly based on evidence of well-designed randomized controlled trials (RCTs), but there are limitations to the transferability of conclusions of RCTs to usual care mainly because the patients enrolled in RCTs are selected and not representative of the population encountered in daily practice; moreover, the research environment is substantially different from that of the real world. Because of the scarcity of data generated in large unselected populations in everyday clinical practice, the possibility of using meta-analyses can be considered. Recently, several meta-analyses have attempted to clarify the role of triple therapy containing a long-acting β-agonist (LABA), a long-acting muscarinic antagonist (LAMA) and an inhaled corticosteroid (ICS) delivered from a single inhaler in chronic obstructive pulmonary disease (COPD), also considering that there is a big difference in the use of triple therapy between what is recommended by COPD guidelines or strategies and the prescriptive behaviour of clinicians. Taking into account the results of the most recent meta-analyses, we believe that triple therapy provides modest clinical benefit in the general COPD population, but in patients on LABA/LAMA combination therapy, who still experience acute exacerbations of COPD (AECOPDs) and have blood eosinophil counts?≥?300 cells·μlsup?1/sup, it is of clinical relevance. On the contrary, adding a LAMA to an ICS/LABA combination elicits relevant clinical benefit in the general COPD population, supporting the role of dual bronchodilation therapy for the treatment of COPD. The quantitative synthesis of the currently available clinical evidence seems to suggest that, in patients with COPD already on ICS/LABA combination, the therapy can be improved without an increase of cardiovascular severe adverse events (SAEs) when a LAMA is added to the combination.
机译：指南主要基于设计良好的随机对照试验（RCT）的证据（RCT），但对RCT对通常护理的结论的可转让性有局限性主要是因为纳入RCT的患者被选中，而不是在日常惯例中遇到的人口;此外，研究环境与现实世界的研究环境不同。由于日常临床实践中大未选择群体中产生的数据稀缺，可以考虑使用Meta-Analys的可能性。最近，几种荟萃分析试图阐明三重治疗含有长效β-激动剂（Laba）的三重疗法，一种长效的毒蕈碱拮抗剂（LAMA）和吸入的皮质类固醇（IC）和从慢性中的单个吸入器递送的吸入皮质类固醇（IC）的作用阻塞性肺病（COPD），还考虑到在COPD指南或策略建议的建议与临床医生的规定行为之间使用三重治疗的差异很大。考虑到最近的Meta分析结果，我们认为三重治疗在一般COPD人群中为普遍存在的临床效益提供了适度的临床益处，而是在Laba / Lama联合治疗的患者中，他仍然经历急性加剧的COPD（AECOPD）并拥有血液嗜酸性粒细胞计数？≥α300细胞·μlβ1，它具有临床相关性。相反，将喇嘛添加到ICS / Laba组合中引发了一般COPD人群中的相关临床益处，支持双支气管扩张治疗对COPD治疗的作用。当前可用的临床证据的定量合成似乎表明，在已经对ICS / Laba组合的COPD患者中，当喇嘛添加到组合时，可以提高治疗而不会增加心血管严重不良事件（SAES）。

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