5/4/2023 0 Comments Lama laba combo![]() ![]() Although the Jadad score rates three out of 10 dimensions of RCT quality, it represents an easy, fast and objective tool for assessing the quality of RCTs, by revealing great overlap with the Cochrane Back Review Group. Ī correct meta-analytic approach should have both quantitative and qualitative characteristics, in order to reveal the biases, strengths and weaknesses of analysed studies. both medications should be administered once daily, for example, and not one on a once-daily and the other on a twice-daily basis. We also believe that the regimen of administration should be consistent between the drugs of each combination, i.e. In any case, the effectiveness of dual bronchodilation should always be compared with at least one of the monocomponents included in the FDCs, and not with different LABAs or LAMAs. In fact, there is solid evidence suggesting that the so-called “dual” bronchodilator therapy has an important role in optimising bronchodilation. ![]() ![]() In particular, we strongly believe that comparing LABA/LAMA FDCs with placebo is anachronistic. These authors performed a sophisticated meta-analysis, but we have identified several critical points in their method that have affected the results and produced quite inconsistent conclusions. has investigated the impact of LABA/LAMA FDCs in COPD with specific regard to the duration of treatment. However, only the meta-analysis published by O ba et al. Since no RCTs exist that have directly compared all relevant treatment options, an indirect treatment comparison via a meta-analytic approach can be an acceptable alternative to quantifying scientific uncertainty. Some meta-analyses have been undertaken in an attempt to improve the gaps in our knowledge in this field. The wide availability of long-acting β 2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combinations (FDCs) in the absence of head-to-head comparative randomised clinical trials (RCTs) makes difficult the choice of combination for the treatment of chronic obstructive pulmonary disease (COPD), a heterogeneous disorder characterised by an enormous variability in drug response between phenotypes. The real gradient of effectiveness of LABA/LAMA fixed-dose combinations remains an unmet medical need however, it can be investigated indirectly using a high-quality meta-analytic approach. Results from previous network meta-analyses were misleading because no adequate attention was given to formulating the review question, specifying eligibility criteria, correctly identifying studies, collecting appropriate information and deciding what it would be pharmacologically relevant to analyse. Significant discrepancies with previous network meta-analyses have been found, with overall differences ranging from 26.7% to 43.3%. No significant publication bias was identified. LABA/LAMA combinations were always more effective than the monocomponents in terms of the improvement in trough forced expiratory volume in 1 s, transition dyspnoea index and St George's Respiratory Questionnaire scores after 3, 6 and 12 months of treatment. Here, we propose and validate a simple and effective approach to meta-analysis for exploring the effectiveness of long-acting β 2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combinations in chronic obstructive pulmonary disease.ġ4 articles with 20 329 patients (combinations n=9292 monocomponents n=11 037) were included in this study. However, meta-analyses may be very misleading if not adequately performed. When there are no randomised clinical trials directly comparing all relevant treatment options, an indirect treatment comparison via meta-analysis of the available clinical evidence is an acceptable alternative.
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