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LABA + ICS reduces exacerbations (NNT = 53 over 6 months), but not hospitalizations
Clinical Question
Is adding a long-acting beta-agonist to an inhaled corticosteroid safe and effective for patients with persistent asthma?
Bottom line
Adding a long-acting beta-agonist (LABA) to an inhaled corticosteroid (ICS) is safe, but does not reduce the likelihood of a serious exacerbation requiring hospitalization. There is a small reduction in nonsevere asthma exacerbations, with one fewer exacerbation for every 53 patients treated for 6 months. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Industry
Setting: Outpatient (any)
Synopsis
The use of a LABA as the sole medication to control asthma was associated with increased mortality. The Federal Drug Administration mandated that companies that make a LABA do adequately powered randomized trials to assess the safety of and efficacy of adding a LABA or placebo to an ICS in patients with persistent asthma. This current study is a pre-planned combined analysis of these four 26-week drug company–sponsored trials. Each study used a different LABA, of course, but results were consistent across trials. There were only 2 asthma-related deaths (both in the ICS-LABA group) and 3 intubations (2 in the ICS group, 1 in the ICS-LABA group). In the combined analysis, there was no significant difference in the risk of hospitalization between groups (0.60% for ICS vs 0.66% for ICS-LABA). The likelihood of an asthma exacerbation was lower in the ICS-LABA group (9.8% vs 11.7%; P < .001; number needed to treat = 53).
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
I actually expected a more robust improvement in asthma burden of disease from this combination.
Bonne confirmation de l’utilité des combinaisons beta-agoniste à longue action avec des corticostéroïdes. Cela aurait intéressant de connaître les groupes d’âge.
A ton of money spent for LABA therapy. Marginal outcome improvement. Study does not comment on LABA drug interactions or harms either. I used to support these combinations for my asthma patients. I’m a lot more cautious now.
"The use of a LABA as the sole medication to control asthma was associated with increased mortality". A good reminder for diagnostic clarity when the distinction between reactive and obstructive airway disease may seem ambiguous.
Good poem