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Network meta-analysis (NMA)

Comparing efficacy of triple therapies among patients with COPD

Multiple RCTs have demonstrated the benefit of triple over dual inhaled therapy in improving lung function and reducing the risk of exacerbation for patients with COPD.1-6

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The evidence gap:

There are currently no head-to-head data comparing FF/UMEC/VI (100/62.5/25 µg) with other single-inhaler triple therapies (BUD/GLY/FOR [320/18/9.6 µg] and BDP/FOR/GLY [100/6/12.5 µg]) for patients with COPD at risk of exacerbation despite dual maintenance therapy.

What is a network meta-analysis (NMA), and why use it?

An NMA allows simultaneous comparison of multiple treatment options in the absence of head-to-head studies. This is made possible by establishing a linked network of evidence. During an NMA, a systematic literature review is conducted, and a network of evidence is linked. This allows both direct and indirect comparisons (through direct RCT evidence and indirect evidence via a common comparator).7,8

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Methodological considerations

NMAs are based on the assumption of:8,9

Similarity

Included trials are similar clinically and methodologically

Consistency

The indirect evidence must be consistent with the direct evidence

Transitivity

There is validity in making indirect comparisons between trials

There are differences in study design and patient populations of the included trials:10

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The similarity assumptions holds for this NMA

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Heterogeneity was seen across multiple studies but was within acceptable limits to allow study comparisons

NMAs can use a fixed effect or random effect approach:8

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In the fixed effect approach, the assumption is that all studies assume one true effect size, and observed differences in estimates between studies is due to sampling error only

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In the random effect approach, the assumption is that sampling error exists but with the expectation that true effect size varies both across studies and across comparisons (direct and indirect)

Continue your journey

NMA class comparison data in COPD

FF/UMEC/VI versus triple and dual bronchodilator therapies

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Summary

Summary of NMA class comparison results for FF/UMEC/VI versus triple and dual bronchodilator therapies

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Abbreviations

BDP, beclomethasone dipropionate; BUD, budesonide; COPD, chronic obstructive pulmonary disease; FF, fluticasone furoate; FOR, formoterol; GLY, glycopyrronium bromide; NMA, network meta-analysis; RCT, randomised controlled trial; UMEC, umeclidinium; VI, vilanterol.

References

  1. Lipson DA, et al. Am J Respir Crit Care Med. 2017;196:438-446.
  2. Lipson DA, et al. N Engl J Med. 2018;378:1671-1680.
  3. Ferguson GT, et al. Lancet Respir Med. 2018;6:747-758.
  4. Rabe KF, et al. N Engl J Med. 2020;383:35-48.
  5. Singh D, et al. Lancet. 2016;388:963-973.
  6. Papi A, et al. Lancet. 2018;391:1076-1084.
  7. Rouse B, et al. Intern Emerg Med. 2017;12:103-111.
  8. Tonin FS, et al. Pharm Pract (Granada). 2017;15:943.
  9. Hoaglin DC, et al. Value Health. 2011;14:429-437.
  10. Ismaila AS, et al. Adv Ther. 2022;39:3957-3978.

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NX-GBL-UCV-WCNT-220014 | Date of preparation: November 2022