Umeclidinium plus vilanterol versus fluticasone propionate plus salmeterol for chronic obstructive pulmonary disease: a meta-analysis of randomized, controlled trials

Chunjuan Zhai; Fen Wang; Ruie Xu; Xia Sun; Wenbin Ma; Li Wang

doi:10.1093/postmj/qgae054

Umeclidinium plus vilanterol versus fluticasone propionate plus salmeterol for chronic obstructive pulmonary disease: a meta-analysis of randomized, controlled trials

Postgrad Med J. 2024 Apr 23:qgae054. doi: 10.1093/postmj/qgae054. Online ahead of print.

Authors

Chunjuan Zhai¹, Fen Wang², Ruie Xu³, Xia Sun⁴, Wenbin Ma⁵, Li Wang¹

Affiliations

¹ Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Huaiyin District, 250021, Jinan, Shandong, China.
² Department of Infection Management, Weishan People's Hospital, No. 10 Chenghou Road, Xiazhen Street, Weishan County, 277600, Jining, Shandong, China.
³ Department of Respiratory, Heze Municipal Hospital, No. 2888 Caozou, Mudan District, 274031, Heze, Shandong, China.
⁴ Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Huaiyin District, 250021, Jinan, Shandong, China.
⁵ School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, 611137, Chengdu, Sichuan, China.

PMID: 38652265
DOI: 10.1093/postmj/qgae054

Abstract

Purpose: Umeclidinium plus vilanterol (UMEC/VI) is an inhaled long-acting muscarinic antagonist/long-acting beta2-agonist (LAMA/LABA), recently approved as once-daily maintenance therapy for chronic obstructive pulmonary disease (COPD). This meta-analysis aims to assess the efficacy and safety of UMEC/VI compared with fluticasone propionate plus salmeterol (FP/SAL).

Methods: A systematic search was conducted by a trained medical research librarian across MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Chinese Biomedical Literature Database (CBM) for randomized controlled trials comparing UMEC/VI with FP/SAL in COPD patients. Two reviewers independently assessed the risk of bias and extracted data. The primary outcome was 0-24 h weighted mean (wm) forced expiratory volume in the first second (FEV1), trough FEV1. The secondary outcomes were other lung functions, symptoms, quality of life, and safety.

Results: Three studies with 2119 patients were included in the meta-analysis. UMEC/VI showed improvement in 0-24 h wm FEV1 (mean difference (MD) 0.08 L, 95% confidence interval (CI) 0.06 to 0.10, P < 0.01, moderate quality) and trough FEV1 (MD 0.09 L, 95% CI 0.07 to 0.11, P < 0.01, moderate quality) in comparison with FP/SAL. UMEC/VI statistically significantly improved all other lung functions compared with FP/SAL. However, there were no significant differences between UMEC/VI and FP/SAL in rescue-medication use, symptomatic endpoints, and health outcomes. UMEC/VI also demonstrated fewer drug-related adverse effects (risk ratio 0.47, 95% CI 0.27 to 0.82, P = 0.01, low quality).

Conclusions: UMEC/VI, when compared with FP/SAL, demonstrated significant improvements in lung functions with fewer drug-related adverse effects. However, the conclusion was limited by the scarcity of studies and long-term trials.

Keywords: COPD; fluticasone/salmeterol; meta-analysis; umeclidinium/vilanterol.