Evidence map›Paper›PMID 31684965›Full record

SynthesisRespiratory research2019

Single-inhaler triple therapy in patients with chronic obstructive pulmonary disease: a systematic review.

Sue Langham, Jen Lewis, Nick Pooley, Nina Embleton, Julia Langham, MeiLan K Han, James D Chalmers

Open access · goldAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Respiratory research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed
3.5field-weighted citation impact, top 6% 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

16 citing papers in PubMed, 33 citations in OpenAlex.

  1. Article
  2. Review
  3. Article
  4. Real-World Use of Inhaled COPD Medications: the Good, the Bad, the Ugly.Chronic obstructive pulmonary diseases (Miami, Fla.) · 2024
    Article
  5. Article
  6. Article
  7. Article
  8. Review
  9. Review
  10. Observational
  11. Article
  12. Article
  13. Review
  14. Article
  15. Review
  16. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 2 countries.

Sue LanghamMaverex Limited, Manchester, UK. suelangham@maverex.com.ORCID http://orcid.org/0000-0003-2088-3333
Jen LewisMaverex Limited, Manchester, UK.
Nick PooleyMaverex Limited, Manchester, UK.
Nina EmbletonMaverex Limited, Manchester, UK.
Julia LanghamMaverex Limited, Manchester, UK.
MeiLan K HanUniversity of Michigan, Women's Respiratory Clinic, Ann Arbor, USA.
James D ChalmersUniversity of Dundee and Ninewells Hospital and Medical School, Dundee, UK.
Intercytex (United Kingdom) · GBUniversity of Dundee · GBUniversity of Michigan · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGuidelines recommend that treatment with a long-acting β

methodsWe conducted a systematic search, from inception to December 2018, of randomised controlled trials (RCTs) of single-inhaler triple therapy in patients with COPD. The primary outcome was the annual rate of moderate and severe exacerbations.

resultsWe identified 523 records, of which 15 reports/abstracts from six RCTs were included. Triple therapy resulted in the reduction of the annual rate of moderate or severe exacerbations in the range of 15-52% compared with LAMA/LABA, 15-35% compared to LABA/ICS and 20% compared to LAMA. The patient-based number needed to treat for the moderate or severe exacerbation outcome ranged between approximately 25-50 (preventing one patient from having an event) and the event-based number needed to treat of around 3-11 (preventing one event). The absolute benefit appeared to be greater in patients with higher eosinophil counts or historical frequency of exacerbations and ex-smokers. In the largest study, there was a significantly higher incidence of pneumonia in the triple therapy arm. There were important differences in study designs and populations impacting the interpretation of the results and indicating there would be significant heterogeneity in cross-trial comparisons.

conclusionThe decision to prescribe triple therapy should consider patient phenotype, magnitude of benefit and increased risk of adverse events. Future research on specific patient phenotype thresholds that can support treatment and funding decisions is now required from well-designed, robust, clinical trials.

trial registrationPROSPERO #CRD42018102125 .

Indexed as

Administration, InhalationAdrenal Cortex HormonesAdrenergic beta-2 Receptor AgonistsAgedBronchodilator AgentsDisease ProgressionDrug Therapy, CombinationFemaleHumansLungMaleMiddle AgedMuscarinic AntagonistsNebulizers and VaporizersPulmonary Disease, Chronic ObstructiveRandomized Controlled Trials as TopicAdrenal Cortex HormonesAdrenergic beta-2 Receptor AgonistsBronchodilator AgentsMuscarinic AntagonistsChronic obstructive pulmonary diseaseCombination drug therapyDisease exacerbationInhalers

Identifiers

PMID31684965
PMCPMC6829989
OpenAlexW2989252965

What OpenQuestion holds

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LicenceCC BY
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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.