ON-DEMAND INHALED BUDESONIDE AND FORMOTEROL COMBINATION THERAPY VERSUS CONVENTIONAL BEST PRACTICE FOR MILD TO MODERATE ASTHMA:

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  • ANDO Koichi
    Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine Internal Medicine Clinic, Showa University Dental Hospital
  • TANAKA Akihiko
    Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine
  • YOKOE Takuya
    Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine
  • OHNISHI Tsukasa
    Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine
  • INOUE Shin
    Internal Medicine Clinic, Showa University Dental Hospital
  • SAGARA Hironori
    Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine

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Other Title
  • 軽症から中等症の気管支喘息患者におけるブデソニド/ホルモテロール合剤発作時頓用療法の従来療法に対する非劣性試験
  • 軽症から中等症の気管支喘息患者におけるブデソニド/ホルモテロール合剤発作時頓用療法の従来療法に対する非劣性試験 : 無作為化比較試験のネットワークメタ解析
  • ケイショウ カラ チュウトウショウ ノ キカンシ ゼンソク カンジャ ニ オケル ブデソニド/ホルモテロールゴウザイ ホッサジトンヨウ リョウホウ ノ ジュウライ リョウホウ ニ タイスル ヒレッセイ シケン : ムサクイカ ヒカク シケン ノ ネットワークメタ カイセキ
  • ―無作為化比較試験のネットワークメタ解析―
  • A NON-INFERIORITY, NETWORK META-ANALYSIS

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Abstract

This study aimed to investigate the non-inferiority of on-demand (OD) budesonide (BUD) and formoterol (FM) combination therapy without any regular treatment (NON-REG+OD-BUD/FM) to the guideline-recommended conventional best practice for mild to moderate asthma. We conducted a network meta-analysis of randomized controlled trials (RCTs) to perform a non-inferiority trial for comparing the efficacy of NON-REG+OD-BUD/FM with regular budesonide with or without formoterol plus on-demand short-acting β2 agonist (REG-BUD+OD-SABA or REG-BUD/FM+OD-SABA) in patients with mild to moderate asthma. PubMed, Cochran library database, and Scopus were searched to identify relevant articles. Outcome measure was asthma control. A network meta-analysis was performed to estimate effect size with a 95% confidence interval (CI). Summary effect size was represented as the mean difference (MD). The probability of being the best treatment for the outcome and the surface under the cumulative ranking (SUCRA) were also calculated. Four RCTs for the treatment of mild to moderate asthma met the criteria and were included in the study. We could not demonstrate non-inferiority of NON-REG+OD-BUD/FM to REG-BUD+OD-SABA or to REG-BUD/FM+OD-SABA in patients with mild to moderate asthma (MD: 0.06, 95% CI: –0.26 to 0.39; MD: 0.15, 95% CI: –0.03 to 0.35, respectively). The probability of the best treatment for asthma control was 5.5% for NON-REG+OD-BUD/FM, 18.1% for REG-BUD+OD-FM, and 76.4% for REG-ICS/LABA+OD-FOBA. Further, SUCRA was 0.2 for NON-REG+OD-BUD/FM, 0.4 for REG-BUD+OD-SABA, and 0.9 for REG-BUD/FM+OD-SABA. Conclusion: These results suggest that NON-REG+OD-BUD/FM has limited effectiveness for asthma control when compared to REG-BUD+OD-FM or REG-ICS/LABA+OD-FOBA. The indications for treatment of mild to moderate asthma need to be carefully considered to optimize patient benefits.

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