Cochrane · systematic review · CD012620
Dual combination therapy versus long‐acting bronchodilators alone for chronic obstructive pulmonary disease (COPD): a systematic review and network meta‐analysis
Oba, Y, Keeney, E, Ghatehorde, N, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
AirwaysAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
36
current version
GRADE rated
33
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 3 · 8.3%Very low 0 · 0%Low 5 · 13.9%Moderate 24 · 66.7%High 4 · 11.1%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
LABA/LAMA compared to LABA/ICS for chronic obstructive pulmonary disease
Population: chronic obstructive pulmonary disease with predicted FEV1 of less than 80%
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Moderate to severe exacerbations: high‐risk population LABA/LAMA vs LABA/ICS | OR 0.87 [0.76, 1] | 1 study · 3372 participants | Moderate Downgraded: imprecision |
Moderate to severe exacerbations: low‐risk population LABA/LAMA vs LABA/ICS | OR 0.86 [0.65, 1.14] | 6 studies · 4315 participants | Moderate Downgraded: imprecision |
Severe exacerbations: high‐risk population LABA/LAMA vs LABA/ICS | OR 0.88 [0.74, 1.06] | 1 study · 3354 participants | Moderate Downgraded: imprecision |
Severe exacerbations: low‐risk population LABA/LAMA vs LABA/ICS | OR 0.66 [0.27, 1.63] | 4 studies · 2860 participants | Moderate Downgraded: imprecision |
Pneumonia: high‐risk population LABA/LAMA vs LABA/ICS | OR 0.62 [0.4, 0.96] | 1 study · 3358 participants | Moderate Downgraded: imprecision |
Pneumonia: low‐risk population LABA/LAMA vs LABA/ICS | OR 0.43 [0.19, 0.97] | 7 studies · 5395 participants | Moderate Downgraded: imprecision |
LABA/LAMA compared to LAMA for chronic obstructive pulmonary disease
Population: chronic obstructive pulmonary disease with predicted FEV1 of less than 80%
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Moderate to severe exacerbations: high‐risk population LABA/LAMA vs LAMA | OR 1.06 [0.89, 1.27] | 1 study · 2206 participants | Moderate Downgraded: imprecision |
Moderate to severe exacerbations: low‐risk population LABA/LAMA vs LAMA | OR 0.93 [0.66, 1.3] | 8 studies · 5192 participants | Low Downgraded: imprecision, inconsistency |
Severe exacerbations: high‐risk population LABA/LAMA vs LAMA | OR 0.73 [0.45, 1.16] | 1 study · 304 participants | Moderate Downgraded: imprecision |
Severe exacerbations: low‐risk population LABA/LAMA vs LAMA | OR 0.99 [0.57, 1.72] | 7 studies · 4937 participants | Moderate Downgraded: imprecision |
Pneumonia: high‐risk population LABA/LAMA vs LAMA | OR 0.98 [0.59, 1.61] | 2 studies · 2510 participants | Moderate Downgraded: imprecision |
Pneumonia: low‐risk population LABA/LAMA vs LAMA | OR 1.23 [0.84, 1.81] | 22 studies · 18538 participants | Moderate |
LABA/LAMA compared to LABA for chronic obstructive pulmonary disease
Population: chronic obstructive pulmonary disease with predicted FEV1 of less than 80%
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Moderate to severe exacerbations: high‐risk population LABA/LAMA vs LABA | no estimate extracted | 0 studies · 0 participants | Ungraded |
Moderate to severe exacerbations: low‐risk population LABA/LAMA vs LABA | OR 0.77 [0.62, 0.97] | 5 studies · 2488 participants | Moderate Downgraded: imprecision |
Severe exacerbations: high‐risk population LABA/LAMA vs LABA | no estimate extracted | 0 studies · 0 participants | Ungraded |
Severe exacerbations: low‐risk population LABA/LAMA vs LABA | OR 0.78 [0.55, 1.12] | 6 studies · 2898 participants | Moderate Downgraded: imprecision |
Pneumonia: high‐risk population LABA/LAMA vs LABA | no estimate extracted | 0 studies · 0 participants | Ungraded |
Pneumonia: low‐risk population LABA/LAMA vs LABA | OR 1.54 [0.95, 2.49] | 10 studies · 8252 participants | Moderate |
LABA/ICS compared to LAMA for chronic obstructive pulmonary disease
Population: chronic obstructive pulmonary disease with predicted FEV1 of less than 80%
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Moderate to severe exacerbations: high‐risk population LABA/ICS vs LAMA | OR 1.12 [0.9, 1.39] | 2 studies · 1580 participants | Moderate Downgraded: imprecision |
Moderate to severe exacerbations: low‐risk population LABA/ICS vs LAMA | OR 0.63 [0.24, 1.66] | 1 study · 623 participants | Low Downgraded: imprecision, publication bias |
Severe exacerbations: high‐risk population LABA/ICS vs LAMA | OR 1.28 [0.95, 1.73] | 2 studies · 1580 participants | Moderate Downgraded: imprecision |
Severe exacerbations: low‐risk population LABA/ICS vs LAMA | OR 3.05 [0.32, 29.47] | 1 study · 623 participants | Low Downgraded: imprecision |
Pneumonia: high‐risk population LABA/ICS vs LAMA | OR 1.8 [1.06, 3.06] | 2 studies · 1580 participants | Moderate Downgraded: imprecision |
Pneumonia: low‐risk population LABA/ICS vs LAMA | OR 5.82 [0.7, 48.8] | 2 studies · 885 participants | Low Downgraded: imprecision, publication bias |
LABA/ICS compared to LABA for chronic obstructive pulmonary disease
Population: chronic obstructive pulmonary disease with predicted FEV1 of less than 80%
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Moderate to severe exacerbations: high‐risk population LABA/ICS vs LABA | OR 0.81 [0.75, 0.89] | 10 studies · 9041 participants | High |
Moderate to severe exacerbations: low‐risk population LABA/ICS vs LABA | OR 0.83 [0.7, 0.98] | 6 studies · 6689 participants | Moderate Downgraded: inconsistency |
Severe exacerbations: high‐risk population LABA/ICS vs LABA | OR 0.91 [0.74, 1.13] | 5 studies · 4216 participants | Moderate Downgraded: imprecision |
Severe exacerbations: low‐risk population LABA/ICS vs LABA | OR 1.06 [0.9, 1.24] | 6 studies · 6482 participants | High |
Pneumonia: high‐risk population LABA/ICS vs LABA | OR 1.46 [1.03, 2.08] | 14 studies · 12586 participants | Moderate |
Pneumonia: low‐risk population LABA/ICS vs LABA | OR 1.64 [1.25, 2.14] | 6 studies · 6705 participants | High |
LAMA compared to LABA for chronic obstructive pulmonary disease
Population: chronic obstructive pulmonary disease with predicted FEV1 of less than 80%
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Moderate to severe exacerbations: high‐risk population LAMA vs LABA | OR 0.84 [0.76, 0.92] | 1 study · 7376 participants | High |
Moderate to severe exacerbations: low‐risk population LAMA vs LABA | OR 0.92 [0.79, 1.07] | 5 studies · 4567 participants | Moderate Downgraded: imprecision |
Severe exacerbations: high‐risk population LAMA vs LABA | OR 0.88 [0.78, 1.01] | 1 study · 7376 participants | Moderate Downgraded: imprecision |
Severe exacerbations: low‐risk population LAMA vs LABA | OR 0.64 [0.36, 1.13] | 4 studies · 3320 participants | Low Downgraded: imprecision |
Pneumonia: high‐risk population LAMA vs LABA | OR 0.83 [0.61, 1.13] | 2 studies · 10815 participants | Moderate |
Pneumonia: low‐risk population LAMA vs LABA | OR 1.01 [0.61, 1.69] | 10 studies · 11338 participants | Moderate |