Efficacy and safety of salmeterol/fluticasone combined with tiotropium <i>versus</i> salmeterol/fluticasone alone for Chinese patients with chronic obstructive pulmonary disease: a meta-analysis _Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZENG Linmiao , YU Xiaolian , YE Kailong , ZHANG Qinghua , SONG Bin , PENG Jinyun ,  XIAO Jianhong

Respiratory Department, Mindong Hospital Affiliated to Fujian Medical University, Fu’an, Fujian 355000, P. R. China;

Corresponding author：

XIAO Jianhong, Email: xjh1030@sina.com

Keywords：

Tiotropium; Salmeterol/fluticasone; Chronic obstructive pulmonary disease; Systematic review; Meta-analysis

DOI：

10.7507/1671-6205.201609021

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Objective To systematically evaluate the efficacy and safety of salmeterol/fluticasone combined with tiotropium versus salmeterol/fluticasone alone for Chinese patients with chronic obstructive pulmonary disease (COPD). Methods The databases including PubMed, EMbase, The Cochrane Library (Issue 4, 2017), CNKI, VIP and WanFang Data were electronically searched to collect randomized controlled trials (RCTs) about salmeterol/fluticasone combined with tiotropium vs. salmeterol/fluticasone alone for Chinese COPD patients from inception to April 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. Results A total of 30 RCTs involving 3 121 Chinese patients were included. The results of meta-analysis showed that, compared with the salmeterol/fluticasone alone group, the salmeterol/fluticasone plus tiotropium group could significantly improve the levels of FEV₁[MD=0.30, 95%CI(0.22, 0.39), P<0.000 01], FVC [MD=0.31, 95%CI (0.23, 0.40), P<0.000 01] and FEV₁/FVC [MD=9.07, 95%CI (6.69, 11.44), P<0.000 01]. While there was no significant difference in adverse reaction rates between the two groups [OR=1.17, 95%CI (0.83, 1.66), P=0.37]. Conclusions Current evidence shows that salmeterol/fluticasone plus tiotropium can improve lung function in Chinese patients with COPD. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.

Citation： ZENG Linmiao, YU Xiaolian, YE Kailong, ZHANG Qinghua, SONG Bin, PENG Jinyun, XIAO Jianhong. Efficacy and safety of salmeterol/fluticasone combined with tiotropium versus salmeterol/fluticasone alone for Chinese patients with chronic obstructive pulmonary disease: a meta-analysis . Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(6): 545-554. doi: 10.7507/1671-6205.201609021 Copy

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36.	冯永刚. 沙美特罗替卡松与噻托溴铵联合对 COPD 患者的应用价值探究. 海峡药学, 2017, 29(2): 200-201.
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1. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南 (2013 年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
2. GOLD Executive Summary (revised 2014) Global strategy for the diagnosis, management and prevention of COPD. [Accessed November 5, 2014]. Available at: http://www.goldcopd.com/.
3. Aaron SD, Vandemheen KL, Fergusson D, et al. Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med, 2007, 146(8): 545-555.
4. Singh D, Brooks J, Hagan G, et al. Superiority of ‘triple’ therapy with salmeterol/fluticasone propionate and tiotropium bromide versus individual components in moderate to severe COPD. Thorax, 2008, 63(7): 592-598.
5. Cazzola M, Ando F, Santus P, et al. A pilot study to assess the effects of combining fluticasone propionate/salmeterol and tiotropium on the airflow obstruction of patients with severe-to-very severe COPD. Pulm Pharmacol Ther, 2007, 20(5): 556-561.
6. 何芳, 张霄, 陈赫军, 等. 系统评价沙美特罗/替卡松 (丙酸氟替卡松) 联用噻托溴铵治疗中、重度慢性阻塞性肺病的临床疗效和安全性. 中国老年学杂志, 2016, 36(23): 5917-5921.
7. 何青, 杨巧玉, 聂汉祥. 沙美特罗替卡松与噻托溴铵联合吸入对稳定期中重度慢性阻塞性肺疾病患者疗效的系统评价. 中国医药导报, 2015, 12(24): 139-145.
8. 曾五一. 统计学概论. 北京: 首都经济贸易大学出版社, 2005, 89.
9. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5. 1. 0). [cited 2012 Jan 5]. Available at: http://www.cochrane-handbook.org.
10. Zeng LM, Yu XL, Yu TT, et al. Interventions for smoking cessation in people diagnosed with lung cancer. Cochrane Database Syst Rev, 2015, (12): CD011751.
11. 戴智康. 噻托溴铵对稳定期慢性阻塞性肺疾病患者呼吸功能及生活质量的影响. 中国基层医药, 2014, 21(19): 2955-2956.
12. 王淑玲, 刘向群, 张杰. 噻托溴铵和沙美特罗/氟替卡松及二者联合吸入治疗慢性阻塞性肺疾病临床观察. 国际呼吸杂志, 2013, 33(1): 1-5.
13. 欧宗兴. 噻托溴铵联合沙美特罗/氟替卡松对慢阻肺稳定期患者肺功能影响. 中国药师, 2012, 15(8): 1157-1159.
14. 陆书生. 噻托溴铵联合沙美特罗替卡松粉吸入剂治疗慢性阻塞性肺疾病观察. 中国药师, 2011, 14(12): 1786-1787.
15. 金梅, 李景会, 迟玉敏, 等. 噻托溴铵联合沙美特罗替卡松对重度极重度慢性阻塞性肺疾病稳定期患者疗效分析. 国际呼吸杂志, 2014, 34(5): 347-350.
16. 刘莉, 罗晨. 联合吸入噻托溴铵及舒利迭对重度 COPD 肺功能和生活质量的影响. 中国地方病防治杂志, 2014, 29(2): 211-212.
17. 张勇华, 陈志军, 张海容, 等. 联合吸入沙美特罗/丙酸氟替卡松及噻托溴铵对改善慢性阻塞性肺疾病肺功能的临床观察. 中国基层医药, 2012, 19(15): 2318-2320.
18. 吴桦, 尚立群, 王水利, 等. 噻托溴铵联合舒利迭治疗稳定期中重度慢性阻塞性肺疾病患者的效果观察. 中国综合临床, 2014, 30(7): 706-708.
19. 宋亚岚. 噻托溴铵联合舒利迭治疗重度与极重度 COPD 的研究. 现代中西医结合杂志, 2014, 23(28): 3127-3129.
20. 谭继玲, 夏庆弟, 刘兰芳. 噻托溴铵与沙美特罗/氟替卡松联合治疗慢性阻塞性肺疾病的临床疗效及院内感染情况分析. 右江民族医学院学报, 2014, 36(5): 705-707.
21. 狄松波. 噻托溴铵联合沙美特罗/丙酸氟替卡松治疗 COPD 稳定期患者的疗效观察. 现代实用医学, 2010, 22(2): 210-211.
22. 熊雪芳, 孙蕾. 沙美特罗/丙酸氟替卡松联合噻托溴铵治疗老年慢性阻塞性肺疾病的临床研究. 中国临床药理学杂志, 2014, 30(4): 291-293.
23. 迟玉敏, 杜俊凤, 姜明明, 等. 沙美特罗替卡松与噻托溴铵联合吸入在重度、极重度 COPD 稳定期中的应用. 中国呼吸与危重监护杂志, 2012, 11(4): 322-325.
24. 李贵芳, 宋亚岚, 刘素钗. 舒利迭联合噻托溴铵治疗对慢性阻塞性肺疾病患者肺功能影响. 现代中西医结合杂志, 2014, 23(30): 3353-3355.
25. 严俊康. 舒利迭联合噻托溴铵治疗慢性阻塞性肺疾病临床疗效观察. 医学信息, 2014, 27(2): 146.
26. 张忠平, 苏阳楚. 吸入噻托溴铵联合舒利迭治疗 COPD 的临床研究. 中外医学研究, 2014, 12(4): 150-151.
27. 孙威. 吸入沙美特罗/氟替卡松联合噻托溴铵对稳定期慢性阻塞性肺疾病患者的疗效观察. 中国实用医刊, 2010, 37(9): 31-32, 35.
28. 杜开颐. 噻托溴铵联合沙美特罗替卡松治疗慢性阻塞性肺疾病稳定期患者的疗效观察. 实用心脑肺血管病杂志, 2012, 20(7): 1118-1119.
29. 华鹏炯. 两种药物对中重度 COPD 患者疗效机制影响的研究. 中国现代医生, 2012, 50(5): 45-46, 49.
30. 韩辉. 舒利迭联合思力华治疗对稳定期慢性阻塞性肺疾病患者的疗效及肺功能的影响. 实用临床医药杂志, 2016, 20(3): 135-136.
31. 李兴刚. 沙美特罗替卡松联合噻托溴铵吸入治疗中重度 COPD 患者效果观察. 临床医学, 2016, 36(5): 43-45.
32. 陆薇, 梁新梅. 噻托溴铵联合舒利迭治疗慢性阻塞性肺疾病的临床疗效观察. 医学理论与实践, 2016, 29(3): 288-289, 308.
33. 张建新, 陈希妍, 吴畏, 等. 噻托溴铵联合沙美特罗替卡松粉吸入治疗慢性阻塞性肺疾病稳定期的疗效. 河北医学, 2016, 22(8): 1265-1267.
34. 张威, 高赏, 任魁, 等. 噻托溴铵和沙美特罗替卡松在 COPD 稳定期患者的应用及对深吸气量的影响. 国际呼吸杂志, 2016, 36(12): 898-901.
35. 王玮, 皇甫秋强. 联合吸入噻托溴铵及沙美特罗丙酸氟替卡松治疗慢性阻塞性肺疾病的临床研究. 中国基层医药, 2015, 22(2): 282-284.
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Chinese Journal of Respiratory and Critical Care Medicine

Efficacy and safety of salmeterol/fluticasone combined with tiotropium versus salmeterol/fluticasone alone for Chinese patients with chronic obstructive pulmonary disease: a meta-analysis

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