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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Pulmonary Medicine 1/2015

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

Zeitschrift:
BMC Pulmonary Medicine > Ausgabe 1/2015
Autoren:
David A Scott, Bethan Woods, Juliette C Thompson, James F Clark, Neil Hawkins, Mike Chambers, Bartolome R. Celli, Peter Calverley
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12890-015-0138-4) contains supplementary material, which is available to authorized users.

Competing interests

Mike Chambers is a GSK employees and owns GSK stock. Funding was provided by GSK.

Authors’ contributions

DAS and JT contributed to the conception and design, acquisition of data and data analysis and interpretation. BW, NH, MC, PC and BC contributed to the conception and design and the data analysis and interpretation. JC contributed to the conception and design and acquisition of data. All authors read and approved the final manuscript.

Abstract

Background

Increasing 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.

Methods

A 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.

Results

The 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.

Conclusion

Results of an NMA of COPD treatments suggest that SFC and indacaterol may reduce mortality. Further research is warranted to strengthen this conclusion.
Zusatzmaterial
Additional file 1: Stastical Methods. (PDF 376 kb)
12890_2015_138_MOESM1_ESM.pdf
Additional file 2: Table S1. Reasons for excluding full publications. Table 2. Risk of bias results. Table S3. Fixed effects network meta-analysis results. Hazard ratios compared to placebo (95% Credible Intervals). Table 4. Placebo mortality by treatment arm. (PDF 352 kb)
12890_2015_138_MOESM2_ESM.pdf
Literatur
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