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Summary

For UMEC/VI the NMA showed outcome benefits compared with other single-inhaler LAMA/LABA dual therapies and monotherapies.1

  • Improvement in trough FEV1:1
    • Significantly greater improvement in lung function at 12 weeks, versus other commonly used single-inhaler dual combinations, except indacaterol/glycopyrronium (IND/GLY) (no significant difference)
    • Significantly greater improvement in lung function at 24 weeks, versus other commonly used single-inhaler dual combinations
    • Significantly greater improvements in lung function at 12 and 24 weeks, versus commonly used monotherapies
  • Heath status:1
    • Significantly greater improvements versus the monotherapies UMEC 125, GLY 18, GLY 50, TIO 18 and SAL 50. There were no statistically significant differences in SGRQ total score at 24 weeks with UMEC/VI compared with other LAMA/LABAs
  • Breathlessness:1
    • Trend towards greater improvements in TDI focal score for UMEC/VI versus monotherapies. Of the dual comparators, UMEC/VI showed a significantly greater improvement versus GLY/FOR 18/9.6 in TDI focal score at 24 weeks
  • Rescue medication use:1
    • Significant reductions in rescue medication use at 24 weeks with UMEC/VI versus all monotherapies (except VI 25). Among dual therapies, UMEC/VI showed a significant improvement versus ACL/FOR 400/12

Considerations1

  • Unknown treatment effect modifiers could bias the results. Only RCTs were included in the NMAs, but randomisation does not control for known treatment effect modifiers across studies
  • This NMA is limited by the availability of data for inclusion. Relatively small sample sizes and sparse networks of evidence in some cases resulted in wide CIs that covered the decision threshold

Safety1

No formal evaluation of safety through statistical analysis was undertaken. Adverse events (AEs) from the trials included in the NMA are tabulated and available in the full publication. In summary:

  • The percentage of patients with ≥ 1 AE ranged from 21% to 94%
  • The percentage of patients with ≥ 1 serious AE ranged from 0.6% to 24.0% 
  • In total, 0.2–33.0% of patients withdrew, and 0.5–10.6% of early withdrawals were due to AEs
  • On-treatment mortality was reported for 0–3.1% of patients
Lung icon

This NMA indicates that UMEC/VI provides favourable outcomes in terms of lung function compared with bronchodilator monotherapies and other LAMA/LABA dual therapies1

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Abbreviations

ACL, aclidinium; AE, adverse event; CI, confidence interval; FEV1, forced expiratory volume in 1 second; FOR, formoterol; GLY, glycopyrronium bromide; IND, indacaterol; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; NMA, network meta-analysis; PBO, placebo; RCT, randomised controlled trial; SAL, salmeterol; SGRQ, St George’s Respiratory Questionnaire; TDI, transition dyspnoea index; TIO, tiotropium; UMEC, umeclidinium; VI, vilanterol.

References

  1. Ismaila AS, et al. Adv Ther. 2022;39:4961-5010.

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NX-GBL-UCV-WCNT-220017 | Date of preparation: February 2023