Mortality and drug therapy in patients with chronic obstructive pulmonary disease: a network meta-analysis

Abstract

BackgroundIncreasing evidence suggests pharmacological treatments may impact on overall survival in Chronic Obstructive Pulmonary Disease (COPD) patients. Individual clinical trials are rarely powered to detect mortality differences between treatments and may not include all treatment options relevant to healthcare decision makers.MethodsA systematic review was conducted to identify RCTs of COPD treatments reporting mortality; evidence was synthesised using network meta-analysis (NMA). The analysis included 40 RCTs; a quantitative indirect comparison between 14 treatments using data from 55,220 patients was conducted.ResultsThe analysis reported two treatments reducing all-cause mortality; salmeterol/fluticasone propionate combination (SFC) was associated with a reduction in mortality versus placebo in the fixed effects (HR 0.79; 95 % Crl 0.67, 0.94) but not the random effects model (0.79; 0.56, 1.09). Indacaterol was associated with a reduction in mortality versus placebo in fixed (0.28; 0.08 to 0.85) and random effects (0.29; 0.08, 0.89) models. Mean estimates and credible intervals for hazard ratios for indacaterol versus placebo are based on a small number of events; estimates may change when the results of future studies are included. These results were maintained across a variety of assumptions and provide evidence that SFC and indacaterol may lead to improved survival in COPD patients.ConclusionResults of an NMA of COPD treatments suggest that SFC and indacaterol may reduce mortality. Further research is warranted to strengthen this conclusion.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0138-4) contains supplementary material, which is available to authorized users.

The feasibility of early pulmonary rehabilitation and activity after COPD exacerbations: external pilot randomised controlled trial, qualitative case study and exploratory economic evaluation

“…Aside from smoking cessation, few interventions have demonstrated reductions in exacerbation frequency, disease progression or mortality. 33 Many patients will receive a review post discharge, predominantly conducted by nursing staff. There is no standard model of exercise following discharge from hospital and the offer of active rehabilitation following AECOPD is not universal, although it is recommended.…”

Chronic obstructive pulmonary disease and long-term mortality in elderly subjects with chronic heart failure

“…It is well known that independently COPD and CHF strongly affect survival in elderly patients [21,22], whereas very little data are available on mortality where patients are simultaneously affected by COPD and CHF. Thus, the aim of the present study was to assess whether the coexistence of COPD would affect long-term mortality in communitydwelling elderly subjects with CHF.…”

Combination Therapy of Inhaled Indacaterol/Glycopyrronium for Chronic Obstructive Pulmonary Disease in the Very Elderly: Is It Safe? An Electrocardiographic Evaluation

“…Noteworthy, in the past, both LAMA and LABA have been associated with adverse CV effects and increased CV mortality [5,6]; however, newer and updated studies have, at least in part, reassured the safety of these compounds [7][8][9].…”