PreprintArticleVersion 1This version is not peer-reviewed
Triple Therapy De-escalation and Withdrawal of Inhaled Corticosteroid to Dual Bronchodilator Therapy in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis
Version 1
: Received: 4 September 2024 / Approved: 5 September 2024 / Online: 6 September 2024 (05:51:50 CEST)
How to cite:
Pirera, E.; Di Raimondo, D.; Tuttolomondo, A. Triple Therapy De-escalation and Withdrawal of Inhaled Corticosteroid to Dual Bronchodilator Therapy in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis. Preprints2024, 2024090414. https://doi.org/10.20944/preprints202409.0414.v1
Pirera, E.; Di Raimondo, D.; Tuttolomondo, A. Triple Therapy De-escalation and Withdrawal of Inhaled Corticosteroid to Dual Bronchodilator Therapy in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis. Preprints 2024, 2024090414. https://doi.org/10.20944/preprints202409.0414.v1
Pirera, E.; Di Raimondo, D.; Tuttolomondo, A. Triple Therapy De-escalation and Withdrawal of Inhaled Corticosteroid to Dual Bronchodilator Therapy in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis. Preprints2024, 2024090414. https://doi.org/10.20944/preprints202409.0414.v1
APA Style
Pirera, E., Di Raimondo, D., & Tuttolomondo, A. (2024). Triple Therapy De-escalation and Withdrawal of Inhaled Corticosteroid to Dual Bronchodilator Therapy in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis. Preprints. https://doi.org/10.20944/preprints202409.0414.v1
Chicago/Turabian Style
Pirera, E., Domenico Di Raimondo and Antonino Tuttolomondo. 2024 "Triple Therapy De-escalation and Withdrawal of Inhaled Corticosteroid to Dual Bronchodilator Therapy in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis" Preprints. https://doi.org/10.20944/preprints202409.0414.v1
Abstract
Background/Objectives: interpretation of evidence on de-escalation of triple therapy with with-drawal of inhaled corticosteroids (ICS) to dual bronchodilator therapy with a long-acting musca-rinic antagonist (LAMA) and a long-acting beta-agonist (LABA) in patients with chronic obstruc-tive pulmonary disease (COPD) is conflicting. We evaluated the efficacy and safety of ICS discon-tinuation from LABA-LAMA-ICS triple therapy compared to its continuation. Methods: we searched PubMed, Embase, Scopus, Web Of Science, clinicaltrial.gov and CENTRAL for RCTs and observational studies from inception to March 22, 2024, investigating the effect of triple therapy de-escalation with withdrawal of ICS to dual therapy on the risk of COPD exacerbation, pneumonia and lung function. This study was registered with PROSPERO, CRD42024527942. Results: 3335 studies were screened; three RCTs and three real-world non-interventional studies were ultimately identified as eligible. Analysis of the time to the first moderate or severe exacerbation showed a pooled HR of 0.96 (95% CI, 0.80 to 1.15; I²=77%) for ICS withdrawal compared with triple therapy continuation. Analysis according eosinophil levels showed that COPD subjects with ≥300 eosino-phils/µL had a significant increase in the incidence of moderate or severe exacerbations when de-escalated from ICS/LABA/LAMA to LABA/LAMA (pooled HR: 1.35, 95% CI 1.00-1.82; I2: 56%). The ICS withdrawal in favour of LABA/LAMA did not significantly affect the risk of mortality and pneumonia. Conclusions: the main findings of this meta-analysis are consistent with current recommendations and suggest that the use of eosinophil counts may be of help in guiding maintenance therapy. However, methodological heterogeneity between the included studies is evident.
Medicine and Pharmacology, Pulmonary and Respiratory Medicine
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
