Médecine pulmonaire et respiratoire

Comparison of Efficacy and Safety Outcomes in Randomized Trials of Long-Acting and Short-Acting ?2-Agonists for Chronic Obstructive Pulmonary Disease: A Review

Abstract

Vamsi K Bollu, John Karafilidis, Ann Colosia, Lee Bennett and Nicola Hanania

Limited information is available comparing the efficacy and safety of Short-Acting β2-agonists (SABAs) versus long-acting β2-agonists (LABAs) for maintenance therapy in Chronic Obstructive Pulmonary Disease (COPD). The objective of this research was to conduct a systematic literature review and evaluate COPD-related outcomes in a meta-analysis. The literature review identified randomized clinical trials of LABAs and SABAs as maintenance therapy in adults with stable COPD. PubMed/Medline, Embase, and the Cochrane Library were searched for reports published between January 1, 1990 and July 16, 2010. Only studies of at least 2 weeks in duration were included. Few studies directly comparing LABAs and SABAs were expected; therefore, studies with placebo or ipratropium were included for a potential indirect-comparison. A total of 938 studies were identified with 62 meeting all inclusion criteria. Only one study directly compared outcomes for LABA versus SABA. This study reported significantly better airflow and greater reduction in symptoms for the LABA treatment. Twelve studies evaluated a SABA with a shared common comparator, but indirect metaanalysis was not tenable due to different outcome variables. The efficacy and safety of LABAs and SABAs in patients with COPD has been demonstrated, but only LABAs have supporting data for maintenance treatment. In usual clinical care, SABAs appear to be used in place of LABAs for long-term therapy, despite the lack of any empirical support. This review supports the current evidence-based guidelines that recommend LABAs for maintenance therapy in adults with stable COPD and reserves SABAs for use as rescue medications.