(81) Efficacy and Safety of Inhaled Corticosteroid Containing Combinations in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis

Publication Number: 755

Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the major public health problems worldwide and it is estimated to be the third leading cause of death by 2030. Inhaled corticosteroid (ICS) containing combinations are commonly prescribed to treat COPD. Still, there are conflicts about their efficacy and safety.

Objectives: To assess the efficacy and safety of Inhaled Corticosteroid containing combinations in patients with moderate to very severe COPD.

Methods: A thorough literature search was performed in PubMed, Cochrane CENTRAL, and Google Scholar from the inception to 31st August 2021. A combination of keywords, MeSH terms, and entry terms on COPD and ICS combinations was used in combination with Boolean operators. All randomized controlled trials (RCTs) investigating the efficacy ((in terms of FEV1, exacerbations, and QoL) and safety (in terms of adverse events and tolerability outcome) of ICS combinations on COPD in comparison with placebo or active comparator were included in the study. The Fixed or Random-effects model was used based on the heterogeneity identified by using the I² statistic and Cochran's Q test.

Results: Out of 2814 non-duplicate RCTs identified through database searching, a total of 28 high-quality studies (Jadad score ≥3), with 36,894 patients were included in this study. ICS combinations showed a significantly better Quality of Life in SGRQ-C score (Mean Deviation (MD): -1.46; 95% CI -2.23, -0.59; P=0.001) and CAT score (MD: -1.08; 95% CI -1.53, -0.63; P= < 0.00001) compared to the control group. There was no significant difference between groups in terms of FEV1 (MD: 32.00ml; 95% CI: -10.84, 74.85; P=0.14), exacerbations (OR:0.85; 95% CI: 0.64, 1.07; P=0.15) and TDI score (MD: -0.03; 95% CI: -0.15, -0.10; P=0.67). From the subgroup analysis, the triple combination therapy with ICS showing a significant improvement in FEV1 (MD: 96.02ml; 95% CI: 55.04, 136.99; P= < 0.00001). Cardio Vascular side effects (OR:0.88; 95% CI: 0.78,1.00; P=0.05) and treatment discontinuation due to lack of efficacy (OR: 0.64; 95% CI: 0.51,0.81; P= 0.0001) was appeared significantly lesser in ICS combinations compared to the control group.

Conclusions: This systematic review and meta-analysis identified a significant association between ICS containing combinations and efficacy outcomes like QoL and CAT score. Less population size and a smaller number of outcomes may be the reason for non-significant results, hence there is a need for large and long-term studies to address these issues further.