1,721,556 research outputs found
Response to letter to the editor. Again on IMPACT: exacerbation after abrupt discontinuation of ICS and pneumonia in fluticasone furoate-containing FDCs
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Bayesian or frequentist: there is no question when comparing single-inhaler triple therapies via network meta-analysis. Focus on fluticasone furoate/umeclidinium/vilanterol fixed-dose combination in chronic obstructive pulmonary disease
No full textobjectives: Single-inhaler triple therapies (SITTs) have never been directly compared in randomized controlled trials (RCTs) in chronic obstructive pulmonary disease (COPD). cochrane recommends the bayesian approach for indirect comparisons but a frequentist network meta-analysis (NMA) reported superiority of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) over other SITT. We assessed the most appropriate inference method for NMA characterized by between-study heterogeneity on SITT in COPD. methods: bayesian and frequentist NMA were performed on RCTs investigating the effect of SITT on exacerbations and trough forced expiratory volume in the 1st second (FEV1) in COPD. results: the included RCTs (ETHOS, FULFIL, IMPACT, KRONOS 200812) reported significant between-study heterogeneity (I-2 > 99%, p < 0.001). the Bayesian random-effect NMA provided unbiased evidence that FF/UMEC/VI was not superior to other SITT on exacerbations and trough FEV1. the frequentist fixed-effect NMA indicated that FF/UMEC/VI was significantly (p < 0.05) more effective than other SITT, although results were affected by dispersion, asymmetry, and significant risk of bias. frequentist random-effect NMA provided effect estimates rather similar but not equal to those of bayesian approach. conclusion: Indirect comparison should be performed via bayesian approach instead of frequentist inference with a fixed-effect model. claiming the superiority of a specific medication over other therapies should be confirmed by findings originating from well-designed RCTs
Tiotropium could provide benefits in the early stage of COPD, but further studies are needed
No full textClinical challenges in applying the new lung function test interpretive strategies: navigating pitfalls and possible solutions
No full textDose of Inhaled Corticosteroids and Cardiovascular Disease in Asthma: An Unexpected Misstep?
No full textImpact of Airway-Occluding Mucus Plugs on Mortality in Patients with COPD According to Disease Severity: A Subset Analysis of Data From COPDGene
No full textBackground: Chronic mucus hypersecretion (CMH) in chronic obstructive pulmonary disease (COPD) is associated with severe outcomes, but its impact on mortality across COPD stages is not well understood. This study evaluated the risk of mortality according to mucus plugs and COPD severity. Methods: A subset analysis was performed using secondary unadjusted data from published figures of a study on the COPDGene cohort. Data on mortality rates and mucus plug scores were extracted and classified by the GOLD stages. The mortality risk was calculated based on the number of mucus plugs occluding lung segments and GOLD stage, using calibration curves and best-fitting non-linear regression curve analysis. Results: The risk of all-cause mortality was significantly increased for GOLD stage 1 patients with ≥1 occluded lung segments (1.48, 95% CI 1.10–1.86; P<0.01) compared to those with no occlusions. Patients with GOLD stage 1 and ≥3 occluded lung segments had a significantly higher mortality risk (1.89, 95% CI 1.43–2.36; P<0.001). No increased mortality risk resulted for patients with 1–2 occluded lung segments and those at GOLD stage 2–4. The number needed to harm analysis indicated that 6 patients with ≥3 occluded segments at GOLD stage 1 were required to observe one death, compared to 26 patients at GOLD stage 4. Conclusion: The significant mortality risk associated with multiple mucus-plugged segments at GOLD stage 1 supports the potential benefit of thiol-based mucolytic therapy. Targeted interventions to reduce mucus plugs could be crucial in improving survival outcomes for early-stage COPD patients
Cardiovascular Events in Chronic Obstructive Pulmonary Disease: Squeezing ETHOS Dry for Clinical Evidence at Risk of Type I Error
No full textComparative effectiveness of indacaterol/glycopyrronium in the treatment of chronic obstructive pulmonary disease
No full textIndacaterol/glycopyrronium has been the first long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combination to be approved as a maintenance treatment in chronic obstructive pulmonary disease patients. Comparative effectiveness studies indicate that it is constantly superior to a LAMA or a LABA alone or even a LABA/inhaled corticosteroid combination, regardless of the drugs used. However, definitive data documenting the benefit of indacaterol/glycopyrronium fixed-dose combination over these consolidated therapies are still absent in a real-world setting, although the results of pivotal randomized controlled trials show that this is the case. Therefore, in addition to the large body of evidence already available supporting the use of indacaterol/glycopyrronium, pragmatic observational studies or ad hoc designed trials should be planned to collect data that could confirm the high effectiveness of indacaterol/glycopyrronium even in the real-life clinical practice
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