論文No1887
Triple therapy versus single and dual long-acting bronchodilator therapy in COPD: a systematic review and meta-analysis
Mario Cazzola, Paola Rogliani, Luigino Calzetta, Maria Gabriella Matera
European Respiratory Journal 52 (6) 1801586; DOI: 10.1183/13993003.01586-2018 Published 13 December 2018
COPDに対してICS/LABA/LAMA or LABA/LAMA or 単剤の気管支拡張薬を比較したメタ解析を行った。
ICS/LABA/LAMAはLABA/LAMAと比較して増悪リスクを減少させ(relative risk 0.70, 95% CI 0.53–0.94)、
トラフのFEV1を増加させた(mean difference in mL +37.94, 95% CI 18.83–53.89)。
ICS/LABA/LAMAのトリプル療法がLABA/LAMAよりも増悪に保護的効果をもたらすのは
血中好酸球が300 cells·µL−1以上の群で大きかった(relative risk 0.57, 95% CI 0.48–0.68)。
1年間ICS/LABA/LAMAで治療してLABA/LAMAより1回の増悪を減らすためには38名の治療が必要だったのに対して、
単剤より1回の増悪を減らすためには21名の治療number needed to treat (NNT)でよかった。
ICS/LABA/LAMA vs LABA/LAMAで個人の１年間のNNTは好酸球300以上では(NNT value: 8.58)、
300未満よりも(NNT value: 46.28)有意に少なかった(p<0.05)。
肺炎リスクはICS/LABA/LAMAとLABA/LAMAで有意差がなかった。
肺炎を起こすNNTは195名であった。
このメタ解析により、単剤の気管支拡張薬やLABA/LAMAを使用しても増悪が多く、
好酸球が300以上のCOPD患者にはICS/LABA/LAMAの効果が期待できるだろうと示唆された。
We performed a meta-analysis to compare the impact of triple combination therapy with inhaled corticosteroids (ICS), long-acting β2-agonists (LABAs) and long-acting muscarinic receptor antagonists (LAMAs) versus LABA/LAMA combination therapy or single long-acting bronchodilator therapy in chronic obstructive pulmonary disease. The ICS/LABA/LAMA combination reduced the risk of exacerbation (relative risk 0.70, 95% CI 0.53–0.94) and improved trough forced expiratory volume in 1 s (mean difference in mL +37.94, 95% CI 18.83–53.89) versus LABA/LAMA combination therapy. The protective effect of triple combination therapy versus LABA/LAMA combination therapy against risk of exacerbation was greater in patients with blood eosinophil counts ≥300 cells·µL−1 (relative risk 0.57, 95% CI 0.48–0.68). While ∼38 patients had to be treated for 1 year with ICS/LABA/LAMA combination therapy to prevent one exacerbation compared to LABA/LAMA combination therapy, the number needed to treat (NNT) was ∼21 when compared to single long-acting bronchodilator therapy. The person-based NNT per year of ICS/LABA/LAMA combination therapy versus LABA/LAMA combination therapy was significantly (p<0.05) lower in patients with eosinophil counts ≥300 cells·µL−1 (NNT value: 8.58) than in those with counts <300 cells·µL−1 (NNT value: 46.28). The risk of pneumonia did not differ between ICS/LABA/LAMA combination therapy and its comparators. The number needed to harm was ∼195. This meta-analysis suggests that patients on single long-acting bronchodilator therapy or LABA/LAMA combination therapy, who still have exacerbations and have blood eosinophil counts ≥300 cells·µL−1, could benefit from ICS/LABA/LAMA combination therapy.