Evidence map›Paper›PMID 24919052›Full record

SynthesisBMJ (Clinical research ed.)2014

Comparative effectiveness of long term drug treatment strategies to prevent asthma exacerbations: network meta-analysis.

Rik J B Loymans, Armin Gemperli, Judith Cohen, Sidney M Rubinstein, Peter J Sterk, Helen K Reddel, Peter Jüni, Gerben ter Riet

Open access · hybridAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 4 pooled it
5.0field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 4 syntheses or guidelines pooled it, 75 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. 2020 Brazilian Thoracic Association recommendations for the management of asthma.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia
    Guideline
  5. Review
  6. Article
  7. Review
  8. Article
  9. Article
  10. Study on Allopathic and Alternative Treatments of Asthma and Factors Influencing Treatment Choices.Evidence-based complementary and alternative medicine : eCAM · 2022
    Article
  11. Article
  12. Article
  13. Review
  14. Article
  15. Emerging Complexity in the Biomarkers of Exacerbation-Prone Asthma.American journal of respiratory and critical care medicine · 2020
    Article
  16. Prognostic value of first-recorded breathlessness for future chronic respiratory and heart disease: a cohort study using a UK national primary care database.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020
    Article
  17. Asthma exacerbation related to viral infections: An up to date summary.Journal of family medicine and primary care · 2019
    Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 3 countries.

Rik J B LoymansDepartment of General Practice, Academic Medical Center, University of Amsterdam, PO box 22700, 1105 DE, Amsterdam, Netherlands r.j.loijmans@amc.nl.
Armin GemperliDivision of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Berne, Switzerland Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland Swiss Paraplegic Research, Nottwil, Switzerland.
Judith CohenDepartment of General Practice, Academic Medical Center, University of Amsterdam, PO box 22700, 1105 DE, Amsterdam, Netherlands.
Sidney M RubinsteinDepartment of Health Sciences, Section Health Economics and Health Technology Assessment, VU University Amsterdam, Amsterdam, Netherlands.
Peter J SterkDepartment of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Helen K ReddelClinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
Peter JüniDivision of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Berne, Switzerland.
Gerben ter RietDepartment of General Practice, Academic Medical Center, University of Amsterdam, PO box 22700, 1105 DE, Amsterdam, Netherlands.
University of Amsterdam · NLAcademic Medical Center · NLInstitute of Social and Preventive Medicine · CHUniversity of Lucerne · CHUniversity of Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine the comparative effectiveness and safety of current maintenance strategies in preventing exacerbations of asthma.

designSystematic review and network meta-analysis using Bayesian statistics. DATA SOURCES: Cochrane systematic reviews on chronic asthma, complemented by an updated search when appropriate. ELIGIBILITY CRITERIA TRIALS OF Adults with asthma randomised to maintenance treatments of at least 24 weeks duration and that reported on asthma exacerbations in full text. Low dose inhaled corticosteroid treatment was the comparator strategy. The primary effectiveness outcome was the rate of severe exacerbations. The secondary outcome was the composite of moderate or severe exacerbations. The rate of withdrawal was analysed as a safety outcome.

results64 trials with 59,622 patient years of follow-up comparing 15 strategies and placebo were included. For prevention of severe exacerbations, combined inhaled corticosteroids and long acting β agonists as maintenance and reliever treatment and combined inhaled corticosteroids and long acting β agonists in a fixed daily dose performed equally well and were ranked first for effectiveness. The rate ratios compared with low dose inhaled corticosteroids were 0.44 (95% credible interval 0.29 to 0.66) and 0.51 (0.35 to 0.77), respectively. Other combined strategies were not superior to inhaled corticosteroids and all single drug treatments were inferior to single low dose inhaled corticosteroids. Safety was best for conventional best (guideline based) practice and combined maintenance and reliever therapy.

conclusionsStrategies with combined inhaled corticosteroids and long acting β agonists are most effective and safe in preventing severe exacerbations of asthma, although some heterogeneity was observed in this network meta-analysis of full text reports.

Indexed as

Administration, InhalationAdrenal Cortex HormonesAdrenergic beta-AgonistsAdultAnti-Asthmatic AgentsAsthmaChronic DiseaseComparative Effectiveness ResearchHumansLong-Term CareNebulizers and VaporizersRandomized Controlled Trials as TopicSelection BiasAdrenal Cortex HormonesAdrenergic beta-AgonistsAnti-Asthmatic Agents

Identifiers

PMID24919052
PMCPMC4019015
OpenAlexW1996092352

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.