Cochrane · systematic review · CD013797
Addition of long‐acting beta2 agonists or long‐acting muscarinic antagonists versus doubling the dose of inhaled corticosteroids (ICS) in adolescents and adults with uncontrolled asthma with medium dose ICS: a systematic review and network meta‐analysis
Oba, Y, Anwer, S, Patel, T, et al. · Cochrane Database of Systematic Reviews · 2023 · 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
43
current version
GRADE rated
29
No studies
7
Included studies
NR
No studies 7 · 16.3%Ungraded 7 · 16.3%Very low 1 · 2.3%Low 6 · 14%Moderate 11 · 25.6%High 11 · 25.6%
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
NMA Summary of findings for severe exacerbations
Population: adolescents and adults with uncontrolled asthma, despite being on medium‐dose ICS Interventions: HD‐ICS, LD‐ICS/LABA, MD‐ICS/LAMA, MD‐ICS/LABA, or HD‐ICS/LABA Control: MD‐ICS Outcome: severe asthma exacerbation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 17 RCTs Total participants: 22,819 | no estimate extracted | 17 studies · 22819 participants | Ungraded |
HD‐ICS (Direct evidence; 4 RCTs; 3003 participants) | no estimate extracted | 4 studies · 3003 participants | Moderate |
LD‐ICS/LABA (Direct evidence; 0 RCTs; 0 participants) | no estimate extracted | 0 studies · 0 participants | Low |
MD‐ICS/LAMA (Direct evidence; 1 RCT; 282 participants) | no estimate extracted | 1 study · 282 participants | Low |
MD‐ICS/LABA (Direct evidence; 10 RCTs; 15,651 participants) | no estimate extracted | 10 studies · 15651 participants | Moderate |
HD‐ICS/LABA (Direct evidence; 3 RCTs; 3319 participants) | no estimate extracted | 3 studies · 3319 participants | Low |
MD‐ICS | no estimate extracted | NR | No studies |
NMA Summary of findings for moderate to severe exacerbations
Population: adolescents and adults with uncontrolled asthma, despite being on medium‐dose ICS Interventions: HD‐ICS, LD‐ICS/LABA, MD‐ICS/LAMA, MD‐ICS/LABA, or HD‐ICS/LABA Control: MD‐ICS Outcome: moderate to severe asthma exacerbation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 25 RCTs Total participants: 25,583 | no estimate extracted | 25 studies · 25583 participants | Ungraded |
HD‐ICS (Direct evidence; 4 RCTs; 1685 participants) | no estimate extracted | 4 studies · 1685 participants | Moderate |
LD‐ICS/LABA (Direct evidence; 0 RCTs; 0 participants) | no estimate extracted | 0 studies · 0 participants | Low |
MD‐ICS/LAMA (Direct evidence; 2 RCTs; 679 participants) | no estimate extracted | 2 studies · 679 participants | Low |
MD‐ICS/LABA (Direct evidence; 12 RCTs; 7569 participants) | no estimate extracted | 12 studies · 7569 participants | Moderate |
HD‐ICS/LABA (Direct evidence; 2 RCTs; 1759 participants) | no estimate extracted | 2 studies · 1759 participants | Moderate |
MD‐ICS | no estimate extracted | NR | No studies |
NMA Summary of findings for change from baseline in ACQ score at 12 months
Population: adolescents and adults with uncontrolled asthma, despite being on medium‐dose ICS Interventions: HD‐ICS, MD‐ICS/LABA, or HD‐ICS/LABA Control: MD‐ICS Outcome: change from baseline in ACQ scores at 12 months
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 4 RCTs Total participants: 5681 | no estimate extracted | 4 studies · 5681 participants | Ungraded |
HD‐ICS (Direct evidence; 2 RCTs; 1005 participants) | no estimate extracted | 2 studies · 1005 participants | High |
MD‐ICS/LABA (Direct evidence; 1 RCT; 774 participants) | no estimate extracted | 1 study · 774 participants | Moderate |
HD‐ICS/LABA (Direct evidence; 2 RCTs; 2863 participants) | no estimate extracted | 2 studies · 2863 participants | High |
MD‐ICS | no estimate extracted | NR | No studies |
NMA Summary of findings for change from baseline in AQLQ score at 6 months
Population: adolescents and adults with uncontrolled asthma, despite being on medium‐dose ICS Interventions: HD‐ICS, LD‐ICS/LABA, MD‐ICS/LABA, or HD‐ICS/LABA Control: MD‐ICS Outcome: change from baseline in AQLQ scores at 6 months
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 6 RCTs Total participants: 4276 | no estimate extracted | 6 studies · 4276 participants | Ungraded |
HD‐ICS (Direct evidence; 0 RCTs; 0 participants) | no estimate extracted | 0 studies · 0 participants | Very low |
LD‐ICS/LABA (Direct evidence; 3 RCTs; 1719 participants) | no estimate extracted | 3 studies · 1719 participants | High |
MD‐ICS/LABA (Direct evidence; 3 RCTs; 1359 participants) | no estimate extracted | 3 studies · 1359 participants | High |
HD‐ICS/LABA (Direct evidence; 0 RCTs; 0 participants) | no estimate extracted | 0 studies · 0 participants | Moderate |
MD‐ICS | no estimate extracted | NR | No studies |
NMA Summary of findings for ACQ responders at 6 months
Population: adolescents and adults with uncontrolled asthma, despite being on medium‐dose ICS Interventions: HD‐ICS, MD‐ICS/LAMA, MD‐ICS/LABA, or HD‐ICS/LABA Control: MD‐ICS Outcome: ACQ response at 6 months
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 6 RCTs Total participants: 7252 | no estimate extracted | 6 studies · 7252 participants | Ungraded |
HD‐ICS (Direct evidence; 1 RCT; 798 participants) | no estimate extracted | 1 study · 798 participants | Low |
MD‐ICS/LAMA (Direct evidence; 3 RCTs; 2219 participants) | no estimate extracted | 3 studies · 2219 participants | Moderate |
MD‐ICS/LABA (Direct evidence; 2 RCTs; 1853 participants) | no estimate extracted | 2 studies · 1853 participants | High |
HD‐ICS/LABA (Direct evidence; 1 RCT; 1210 participants) | no estimate extracted | 1 study · 1210 participants | High |
MD‐ICS | no estimate extracted | NR | No studies |
NMA Summary of findings for ACQ responders at 12 months
Population: adolescents and adults with uncontrolled asthma, despite being on medium‐dose ICS Interventions: HD‐ICS, MD‐ICS/LABA, or HD‐ICS/LABA Control: MD‐ICS Outcome: ACQ response at 12 months
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 3 RCTs Total participants: 3828 | no estimate extracted | 3 studies · 3828 participants | Ungraded |
HD‐ICS (Direct evidence; 2 RCTs; 1011 participants) | no estimate extracted | 2 studies · 1011 participants | Moderate |
MD‐ICS/LABA (Direct evidence; 1 RCT; 774 participants) | no estimate extracted | 1 study · 774 participants | Moderate |
HD‐ICS/LABA (Direct evidence; 1 RCT; 1167 participants) | no estimate extracted | 1 study · 1167 participants | High |
MD‐ICS | no estimate extracted | NR | No studies |
NMA Summary of findings for dropouts due to AEs
Population: adolescents and adults with uncontrolled asthma, despite being on medium‐dose ICS Interventions: HD‐ICS, LD‐ICS/LABA, MD‐ICS/LAMA, MD‐ICS/LABA, or HD‐ICS/LABA Control: MD‐ICS Outcome: dropouts due to AEs
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 34 RCTs Total participants: 32,684 | no estimate extracted | 34 studies · 32684 participants | Ungraded |
HD‐ICS (Direct evidence; 6 RCTs; 2211 participants) | no estimate extracted | 6 studies · 2211 participants | High |
LD‐ICS/LABA (Direct evidence; 1 RCT; 5846 participants) | no estimate extracted | 1 study · 5846 participants | High |
MD‐ICS/LAMA (Direct evidence; 4 RCTs; 2239 participants) | no estimate extracted | 4 studies · 2239 participants | Moderate |
MD‐ICS/LABA (Direct evidence; 21 RCTs; 20326 participants) | no estimate extracted | 21 studies · 20326 participants | High |
HD‐ICS/LABA (Direct evidence; 4 RCTs; 2750 participants) | no estimate extracted | 4 studies · 2750 participants | High |
MD‐ICS | no estimate extracted | NR | No studies |