Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis.

Abstract:

OBJECTIVE:To compare the rate of moderate to severe exacerbations between triple therapy and dual therapy or monotherapy in patients with chronic obstructive pulmonary disease (COPD). DESIGN:Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES:PubMed, Embase, Cochrane databases, and clinical trial registries searched from inception to April 2018. ELIGIBILITY CRITERIA:Randomised controlled trials comparing triple therapy with dual therapy or monotherapy in patients with COPD were eligible. Efficacy and safety outcomes of interest were also available. DATA EXTRACTION AND SYNTHESIS:Data were collected independently. Meta-analyses were conducted to calculate rate ratios, hazard ratios, risk ratios, and mean differences with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations assessment, development, and evaluation). RESULTS:21 trials (19 publications) were included. Triple therapy consisted of a long acting muscarinic antagonist (LAMA), long acting β agonist (LABA), and inhaled corticosteroid (ICS). Triple therapy was associated with a significantly reduced rate of moderate or severe exacerbations compared with LAMA monotherapy (rate ratio 0.71, 95% confidence interval 0.60 to 0.85), LAMA and LABA (0.78, 0.70 to 0.88), and ICS and LABA (0.77, 0.66 to 0.91). Trough forced expiratory volume in 1 second (FEV1) and quality of life were favourable with triple therapy. The overall safety profile of triple therapy is reassuring, but pneumonia was significantly higher with triple therapy than with dual therapy of LAMA and LABA (relative risk 1.53, 95% confidence interval 1.25 to 1.87). CONCLUSIONS:Use of triple therapy resulted in a lower rate of moderate or severe exacerbations of COPD, better lung function, and better health related quality of life than dual therapy or monotherapy in patients with advanced COPD. STUDY REGISTRATION:Prospero CRD42018077033.

journal_name

BMJ

authors

Zheng Y,Zhu J,Liu Y,Lai W,Lin C,Qiu K,Wu J,Yao W

doi

10.1136/bmj.k4388

subject

Has Abstract

pub_date

2018-11-06 00:00:00

pages

k4388

eissn

0959-8138

issn

1756-1833

journal_volume

363

pub_type

杂志文章,meta分析
  • Postapproval studies of drugs initially approved by the FDA on the basis of limited evidence: systematic review.

    abstract::Objective To characterize the prospective controlled clinical studies for all novel drugs that were initially approved by the Food and Drug Administration on the basis of limited evidence.Design Systematic review.Data sources Drugs@FDA database and PubMed.Study inclusion All prospective controlled clinical studies pub...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,评审

    doi:10.1136/bmj.j1680

    authors: Pease AM,Krumholz HM,Downing NS,Aminawung JA,Shah ND,Ross JS

    更新日期:2017-05-03 00:00:00

  • Impact of stepping stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial.

    abstract:OBJECTIVE:To assess the impact of Stepping Stones, a HIV prevention programme, on incidence of HIV and herpes simplex type 2 (HSV-2) and sexual behaviour. DESIGN:Cluster randomised controlled trial. SETTING:70 villages (clusters) in the Eastern Cape province of South Africa. PARTICIPANTS:1360 men and 1416 women aged...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.a506

    authors: Jewkes R,Nduna M,Levin J,Jama N,Dunkle K,Puren A,Duvvury N

    更新日期:2008-08-07 00:00:00

  • Psychosis with good prognosis in Afro-Caribbean people now living in the United Kingdom.

    abstract:OBJECTIVES:To compare the course and outcome of psychotic illness in a group of Afro-Caribbean patients resident in the United Kingdom and a group of white British patients. DESIGN:Cohort study of consecutive admissions followed up for four years. SUBJECTS:113 patients with psychotic illness of recent onset admitted ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.311.7016.1325

    authors: McKenzie K,van Os J,Fahy T,Jones P,Harvey I,Toone B,Murray R

    更新日期:1995-11-18 00:00:00

  • Safety and effectiveness of first line eflornithine for Trypanosoma brucei gambiense sleeping sickness in Sudan: cohort study.

    abstract:OBJECTIVE:To assess the safety and effectiveness of eflornithine as first line treatment for human African trypanosomiasis. DESIGN:Cohort study. SETTING:Control programme in Ibba, southern Sudan. PARTICIPANTS:1055 adults and children newly diagnosed with second stage disease in a 16 month period. MAIN OUTCOME MEASU...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.39485.592674.BE

    authors: Priotto G,Pinoges L,Fursa IB,Burke B,Nicolay N,Grillet G,Hewison C,Balasegaram M

    更新日期:2008-03-29 00:00:00

  • Progression of HIV disease in a haemophilic cohort followed for 11 years and the effect of treatment.

    abstract:OBJECTIVE:To describe the progression of HIV disease in a haemophilic cohort and to show the influence of treatment. DESIGN:11 year longitudinal clinical and laboratory study. SETTING:A haemophilia centre. PATIENTS:111 patients infected with HIV during October 1979 to July 1985. MAIN OUTCOME MEASURES:Symptoms of HI...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章

    doi:10.1136/bmj.303.6810.1093

    authors: Lee CA,Phillips AN,Elford J,Janossy G,Griffiths P,Kernoff P

    更新日期:1991-11-02 00:00:00

  • NHSnet in Scottish primary care: lessons for the future.

    abstract:OBJECTIVE:To evaluate the primary care communications initiative, which introduced NHSnet to primary care in Scotland. DESIGN:Semi-structured telephone interviews, postal questionnaire. SETTING:All 15 Scottish health boards, random sample of 1 in 3 of all Scottish general practices. PARTICIPANTS:Information manageme...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.321.7265.878

    authors: Willmot M,Sullivan F

    更新日期:2000-10-07 00:00:00

  • Effects of alternative maternal micronutrient supplements on low birth weight in rural Nepal: double blind randomised community trial.

    abstract:OBJECTIVE:To assess the impact on birth size and risk of low birth weight of alternative combinations of micronutrients given to pregnant women. DESIGN:Double blind cluster randomised controlled trial. SETTING:Rural community in south eastern Nepal. PARTICIPANTS:4926 pregnant women and 4130 live born infants. INTER...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.326.7389.571

    authors: Christian P,Khatry SK,Katz J,Pradhan EK,LeClerq SC,Shrestha SR,Adhikari RK,Sommer A,West KP Jr

    更新日期:2003-03-15 00:00:00

  • Impact of misclassification of in vitro fertilisation in studies of folic acid and twinning: modelling using population based Swedish vital records.

    abstract:OBJECTIVE:To determine whether failure to adequately adjust for a reported 40% misclassification of use of in vitro fertilisation (IVF) as reported in a Swedish study could have led to a false finding that folic acid increases dizygotic twinning. DESIGN:Modelling with population based data. SETTING:Swedish vital reco...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.38369.437789.82

    authors: Berry RJ,Kihlberg R,Devine O

    更新日期:2005-04-09 00:00:00

  • Prophylaxis and follow-up after possible exposure to HIV, hepatitis B virus, and hepatitis C virus outside hospital: evaluation of policy 2000-3.

    abstract:PROBLEM:Prophylactic treatment and follow-up after exposure to HIV, hepatitis B, and hepatitis C outside hospital needs to be improved. BACKGROUND AND SETTING:Until January 2000, people in Amsterdam could report exposure outside hospital to either a hospital or the municipal health service. If they reported to the mun...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.330.7495.825

    authors: Sonder GJ,Regez RM,Brinkman K,Prins JM,Mulder JW,Spaargaren J,Coutinho RA,van den Hoek A

    更新日期:2005-04-09 00:00:00

  • Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence.

    abstract:OBJECTIVE:To examine the effectiveness of parenteral corticosteroids for the relief of acute severe migraine headache and prevention of recurrent headaches. DESIGN:Meta-analysis. DATA SOURCES:Electronic databases (Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS, and CINAHL), conference proceed...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1136/bmj.39566.806725.BE

    authors: Colman I,Friedman BW,Brown MD,Innes GD,Grafstein E,Roberts TE,Rowe BH

    更新日期:2008-06-14 00:00:00

  • Occurrence and repetition of hospital admissions for accidents in preschool children.

    abstract:OBJECTIVES:To examine trends over time in the rates of admission to hospital for accidents of preschool children and to study patterns of repeated admissions for accidents in these children. DESIGN:Analysis of linked, routine abstracts of hospital inpatient records for accidents. SETTING:Six districts in the Oxford R...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.302.6767.16

    authors: Sellar C,Ferguson JA,Goldacre MJ

    更新日期:1991-01-05 00:00:00

  • Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction.

    abstract:OBJECTIVES:To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweete...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1136/bmj.h3576

    authors: Imamura F,O'Connor L,Ye Z,Mursu J,Hayashino Y,Bhupathiraju SN,Forouhi NG

    更新日期:2015-07-21 00:00:00

  • Effect of routine zinc supplementation on pneumonia in children aged 6 months to 3 years: randomised controlled trial in an urban slum.

    abstract:OBJECTIVES:To evaluate the effect of daily zinc supplementation in children on the incidence of acute lower respiratory tract infections and pneumonia. DESIGN:Double masked, randomised placebo controlled trial. SETTING:A slum community in New Delhi, India. PARTICIPANTS:2482 children aged 6 to 30 months. INTERVENTIO...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.324.7350.1358

    authors: Bhandari N,Bahl R,Taneja S,Strand T,Mølbak K,Ulvik RJ,Sommerfelt H,Bhan MK

    更新日期:2002-06-08 00:00:00

  • Particulate air pollution and mortality in 38 of China's largest cities: time series analysis.

    abstract::Objectives To estimate the short term effect of particulate air pollution (particle diameter <10 μm, or PM10) on mortality and explore the heterogeneity of particulate air pollution effects in major cities in China.Design Generalised linear models with different lag structures using time series data.Setting 38 of the ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.j667

    authors: Yin P,He G,Fan M,Chiu KY,Fan M,Liu C,Xue A,Liu T,Pan Y,Mu Q,Zhou M

    更新日期:2017-03-14 00:00:00

  • First day neonatal mortality since 1935: re-examination of the Cross hypothesis.

    abstract:OBJECTIVES:To describe the change in first day infant mortality during 1935-87. To examine the hypothesis that excess first day mortality in the 1950s and 1960s was attributable to restricting oxygen for sick newborn infants. DESIGN:Time series analysis of first day infant mortality and stillbirth rates. SETTING:Engl...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.304.6823.343

    authors: Whyte RK

    更新日期:1992-02-08 00:00:00

  • Community survey of factors associated with consultation for low back pain.

    abstract:OBJECTIVE:To investigate the psychosocial factors associated with consultation for low back pain. DESIGN:Two phase cross sectional postal survey. SETTING:Bradford Metropolitan Health District. SUBJECTS:1813 adults responding to the phase 1 questionnaire. 540 of the 782 with an episode of low back pain in the past 12...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.317.7172.1564

    authors: Waxman R,Tennant A,Helliwell P

    更新日期:1998-12-05 00:00:00

  • Effect of different forms of information produced for cancer patients on their use of the information, social support, and anxiety: randomised trial.

    abstract:OBJECTIVE:To explore the hypothesis that different methods of selecting and printing information for cancer patients could improve emotional support by affecting interaction with others, and so lead to improved psychological wellbeing. DESIGN:Randomised trial with eight groups (three factors, 2x2x2). Data collected at...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,随机对照试验

    doi:10.1136/bmj.38807.571042.68

    authors: Jones RB,Pearson J,Cawsey AJ,Bental D,Barrett A,White J,White CA,Gilmour WH

    更新日期:2006-04-22 00:00:00

  • Coronary heart disease prevention: insights from modelling incremental cost effectiveness.

    abstract:OBJECTIVE:To determine which treatments for preventing coronary heart disease should be offered to which patients by assessing their incremental cost effectiveness. DESIGN:Modelling study. DATA SOURCES:Cost estimates (for NHS) and estimates of effectiveness obtained for aspirin, antihypertensive drugs, statins and cl...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.327.7426.1264

    authors: Marshall T

    更新日期:2003-11-29 00:00:00

  • Role of molecular cell biology in understanding disease.

    abstract::Molecular techniques have revolutionised our knowledge of cell and tissue function in both health and disease. We already have new and powerful treatments based on an understanding of communication between cells by messenger molecules called cytokines. Furthermore, there is great therapeutic promise in defining molecu...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,评审

    doi:10.1136/bmj.314.7075.203

    authors: Savill J

    更新日期:1997-01-18 00:00:00

  • Disease management.

    abstract::The disease management approach to patient care seeks to coordinate resources across the healthcare delivery system. The growing interest in evidence based medicine and outcomes, and a commitment to integrated care across the primary, secondary, and community care sectors, all contribute to making disease management a...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.315.7099.50

    authors: Hunter DJ,Fairfield G

    更新日期:1997-07-05 00:00:00

  • Randomised placebo controlled multicentre trial to assess short term clarithromycin for patients with stable coronary heart disease: CLARICOR trial.

    abstract:OBJECTIVE:To determine if the macrolide clarithromycin affects mortality and cardiovascular morbidity in patients with stable coronary heart disease. DESIGN:Centrally randomised multicentre trial. All parties at all stages were blinded. Analyses were by intention to treat. SETTING:Five Copenhagen University cardiolog...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.38666.653600.55

    authors: Jespersen CM,Als-Nielsen B,Damgaard M,Hansen JF,Hansen S,Helø OH,Hildebrandt P,Hilden J,Jensen GB,Kastrup J,Kolmos HJ,Kjøller E,Lind I,Nielsen H,Petersen L,Gluud C,CLARICOR Trial Group.

    更新日期:2006-01-07 00:00:00

  • Computerisation of primary care in Wales.

    abstract:OBJECTIVE:To obtain information about the computerisation of general practice in Wales, and to enable more effective planning of educational provision for doctors and other primary health care workers. DESIGN:Postal questionnaire sent to all general practices in Wales. SUBJECTS:553 general practices, of which 401 (73...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.303.6794.93

    authors: Goves JR,Davies T,Reilly T

    更新日期:1991-07-13 00:00:00

  • Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study.

    abstract:OBJECTIVES:To assess the compliance of Asian intensive care units and hospitals to the Surviving Sepsis Campaign's resuscitation and management bundles. Secondary objectives were to evaluate the impact of compliance on mortality and the organisational characteristics of hospitals that were associated with higher compli...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.d3245

    authors: Phua J,Koh Y,Du B,Tang YQ,Divatia JV,Tan CC,Gomersall CD,Faruq MO,Shrestha BR,Gia Binh N,Arabi YM,Salahuddin N,Wahyuprajitno B,Tu ML,Wahab AY,Hameed AA,Nishimura M,Procyshyn M,Chan YH,MOSAICS Study Group.

    更新日期:2011-06-13 00:00:00

  • Routine follow up of breast cancer in primary care: randomised trial.

    abstract:OBJECTIVE:To assess the effect on time to diagnosis of recurrence and on quality of life of transferring primary responsibility for follow up of women with breast cancer in remission from hospital to general practice. DESIGN:Randomised controlled trial with 18 month follow up in which women received routine follow up ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.313.7058.665

    authors: Grunfeld E,Mant D,Yudkin P,Adewuyi-Dalton R,Cole D,Stewart J,Fitzpatrick R,Vessey M

    更新日期:1996-09-14 00:00:00

  • Understanding help seeking behaviour among male offenders: qualitative interview study.

    abstract:OBJECTIVE:To explore the factors that influence help seeking for mental distress by offenders. DESIGN:Qualitative study based on in-depth interviews with prisoners before and after release. SETTING:One category B local prison in southern England. PARTICIPANTS:35 male offenders aged 18-52, a quarter of whom had been ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.39059.594444.AE

    authors: Howerton A,Byng R,Campbell J,Hess D,Owens C,Aitken P

    更新日期:2007-02-10 00:00:00

  • Effect of correcting outcome data for case mix: an example from stroke medicine.

    abstract:OBJECTIVE:To show the influence of variations in case mix on clinical outcome indicators for patients admitted to hospital with acute stroke. DESIGN:"Before and after" cohort study, with prospective, consecutive identification of patients and prospective follow up; multiple logistic regression analyses to correct for ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.312.7045.1503

    authors: Davenport RJ,Dennis MS,Warlow CP

    更新日期:1996-06-15 00:00:00

  • Diabetes registers: a grassroots approach.

    abstract:OBJECTIVES:To compile a register of diabetic patients within the catchment area of a district general hospital and evaluate the characteristics of the population using aggregated data from a general practice audit. DESIGN:Cross sectional study. Practices identified all known diabetics and completed a questionnaire fro...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.307.6911.1046

    authors: Howitt AJ,Cheales NA

    更新日期:1993-10-23 00:00:00

  • Science, medicine, and the future. Lung cancer.

    abstract::Lung cancer, the most prevalent cancer in the Western world, is mainly caused by smoking. Nevertheless, only 20% of smokers develop lung cancer and while prevention is important, environmental factors are expected to contribute to the predicted rise in the incidence of lung cancer in the next 25 years. Survival of lun...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,评审

    doi:10.1136/bmj.314.7081.652

    authors: Sethi T

    更新日期:1997-03-01 00:00:00

  • Inequalities in self rated health in the 1958 birth cohort: lifetime social circumstances or social mobility?

    abstract:OBJECTIVE:To investigate explanations for social inequalities in health with respect to health related social mobility and cumulative socioeconomic circumstances over the first three decades of life. DESIGN:Longitudinal follow up. SETTING:Great Britain. SUBJECTS:Data from the 1958 birth cohort study (all children bo...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.313.7055.449

    authors: Power C,Matthews S,Manor O

    更新日期:1996-08-24 00:00:00

  • Avoiding the pitfalls of sponsored multicentre research in general practice.

    abstract::Research in general practice is becoming increasingly popular, and most general practitioners will sooner or later have to decide whether to become involved with clinical trials sponsored by drug companies. This paper outlines the advantages and disadvantages of multicentre research--based on experience of running a r...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.307.6915.1331

    authors: Waldron HA,Cookson RF

    更新日期:1993-11-20 00:00:00