Table H-14Strength of evidence for the comparative efficacy of LABA + ICS and LTRA

Number of studies (# of subjects)DesignQualityConsistencyDirectnessMagnitude of effectOther modifying factorsOverall strength of evidence
Overall total: ML compared with FP + SM
5 (2,188)RCTs (12 to 48 weeks)Good (1)
Fair (4)
ConsistentDirectFP+SM > ML

Greater improvement in symptom-free days (SMD − 0.25, 95% CI: −0.35, −0.15) and percentage of rescue medicine-free days (SMD − 0.27, 95% CI: −0.37, −0.17)

Fewer exacerbations (SMD 0.26, 95% CI: 0.16, 0.35)
NoneHigh

Abbreviations: CI = confidence interval; FP = Fluticasone Propionate; ICS = Inhaled Corticosteroids; LABAs = Long-Acting Beta-2 Agonists; LTRAs = Leukotriene receptor antagonists; ML = Montelukast; RCT= randomized controlled trial; SM = Salmeterol; SMD=standard mean difference.

Symbol use: Drug X > Drug Y = statistically significant difference in outcomes favoring Drug X; Drug X > Drug Y trend = point estimate favors Drug X, but the difference is not statistically significant or tests of statistical significance were NR; No difference = no statistically significant difference or tests of statistical significance were not reported and outcomes are similar.

From: Appendix H, Strength of evidence

Cover of Drug Class Review: Controller Medications for Asthma
Drug Class Review: Controller Medications for Asthma: Final Update 1 Report [Internet].
Jonas DE, Wines RCM, DelMonte M, et al.
Portland (OR): Oregon Health & Science University; 2011 Apr.
Copyright © 2011 by Oregon Health & Science University.

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