Paola Rogliani, Beatrice Ludovica Ritondo,Josuel Ora, Mario Cazzola, Luigino Calzetta
European Respiratory Journal 2020 56: 2000625; DOI: 10.1183/13993003.00625-2020
To date, there are no network meta-analyses comparing the impact of as-needed treatments in asthma, including the single maintenance and reliever therapy (known as “SMART” or “MART”; for simplicity, SMART will be used hereafter) and the use of inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination exclusively on an as-needed basis. Therefore, we performed a systematic review and network meta-analysis concerning the efficacy and safety of SMART and as-needed therapies in asthma. Data from 32 096 asthmatic patients were extracted from 21 studies, lasting from 6 to 12 months. In adult mild-to-moderate asthmatic patients low-dose SMART and as-needed low-dose ICS/LABA combination were significantly (relative effect <0.78; p<0.05) more effective than the other as-needed therapies in reducing the risk of exacerbation, and both were ranked as the first treatment option reaching the first quartile of the surface under the cumulative ranking curve analysis (SUCRA). In adult moderate-to-severe asthmatic patients, low-dose to medium-dose SMART and high-dose ICS/LABA+as-needed short-acting β2-agonist were equally effective in reducing the risk of severe asthma exacerbation (p>0.05), although only low- to medium-dose SMART was ranked as the first treatment option (first SUCRA quartile). Overall, these treatments were well tolerated, and effective also on lung function and disease control. This study supports SMART and as-needed therapies as a suitable therapeutic option for asthma, by providing the most effective positioning of each specific treatment according to the disease severity.
As-needed therapy represents a suitable therapeutic option in the treatment of asthma, with single maintenance and reliever therapy and as-needed ICS/LABA being the most effective therapeutic options https://bit.ly/3dEIXh4
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Author contributions: P. Rogliani, B.L. Ritondo, J. Ora, M. Cazzola and L. Calzetta had full access to all of the data in the study and take the responsibility for the integrity of the data and the accuracy of the data analysis. P. Rogliani, B.L. Ritondo and L. Calzetta designed the statistical analyses in consultation with J. Ora and M. Cazzola. P. Rogliani and L. Calzetta wrote the first draft of the article, in consultation with J. Ora, B.L. Ritondo and M. Cazzola for data interpretations. All authors revised the article critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the article in ensuring that questions related to the accuracy or integrity of any part of the article were appropriately investigated and resolved. P. Rogliani and L. Calzetta are the guarantors of this review and meta-analysis.
Conflict of interest: P. Rogliani reports grants and personal fees from Boehringer Ingelheim, Novartis, Chiesi Farmaceutici and Almirall, personal fees from AstraZeneca, Biofutura, GlaxoSmithKline, Menarini and Mundipharma, grants from Zambon, outside the submitted work.
Conflict of interest: B.L. Ritondo has nothing to disclose.
Conflict of interest: J. Ora has nothing to disclose.
Conflict of interest: M. Cazzola reports grants and personal fees from Boehringer Ingelheim, Novartis, Almirall and Zambon, personal fees from AstraZeneca, Chiesi Farmaceutici, ABC Farmaceutici, Edmond Pharma, Verona Pharma, Ockham Biotech, Biofutura, GlaxoSmithKline, Menarini, Lallemand, Mundipharma and Pfizer, outside the submitted work.
Conflict of interest: L. Calzetta reports grants and personal fees from Boehringer Ingelheim, Novartis and Zambon, non-financial support from AstraZeneca, grants from Chiesi Farmaceutici and Almirall, personal fees from ABC Farmaceutici, Edmond Pharma, Verona Pharma and Ockham Biotech, outside the submitted work.