Table H-8Strength of evidence for the comparative efficacy of ICSs and LABAs for monotherapy

Number of studies (#of subjects)DesignQualityConsistencyDirectnessResults, magnitude of effectOther modifying factorsaOverall strength of evidence
ICS compared with LABA for monotherapy
13 (4196)RCTsGood (1)
Fair (12)
Some inconsistencyDirectLABAs had a significantly higher odds of exacerbations than ICSs (OR = 2.845; 95% CI = 1.664, 4.863; P < 0.001; 6 studies)); no statistically significant difference found in meta-analyses of other outcomesbNoneHigh
FP compared with SM
7 (2262)RCTsFairSome inconsistencyDirectFewer exacerbations with FP than SM; mixed results for other outcomes, but trials generally reported no differences or better outcomes for those treated with FP than with SMNoneHigh
BDP compared with SM
3 (694)RCTsFairSome inconsistencyDirectMixed results, but trials generally reported no differences or better outcomes for those treated with BDP than with SMNoneHigh
TAA compared with SM
1 (164)RCT (16 weeks)GoodNADirectFewer patients having exacerbations with TAA (7% compared with 20%, P = 0.04) and lower treatment failure rate (6% compared with 24%, P−0.004); no difference in symptoms, rescue use, or QOLNoneModerate
BUD compared with FM
2 (1076)RCTs (12 weeks)FairNADirectTrend toward fewer symptoms, nocturnal awakenings, and exacerbations; trend toward less rescue useNoneModerate

Abbreviations: BDP = beclomethasone dipropionate; BUD = Budesonide; CI = confidence interval; FM = Formoterol; FP = Fluticasone Propionate; ICS = Inhaled Corticosteroids; LABAs = Long-Acting Beta-2 Agonists; NR = not reported; QOL = quality of life; RCT= randomized controlled trial; SM = Salmeterol; SMD = standard mean difference; TAA = triamcinolone acetonide.

a

Imprecise or sparse data; a strong or very strong association; high risk of reporting bias; dose response gradient; effect of plausible residual confounding.

b

The selected results are from our meta-analyses of included RCTs; the complete meta-analyses are in Appendix I.

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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