Objective To systematically evaluate the clinical efficacy and safety of fluticasone furoate in the treatment of bronchial asthma. Methods We electronically searched databases including PubMed, The Cochrane Library (Issue 2, 2016), CNKI, VIP, and WanFang Data to collect randomized controlled trials (RCTs) about fluticasone furoate for bronchial asthma from inception to Feb. 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results Six RCTs involving 4 383 patients were included. The results of meta-analysis showed that: (1) Fluticasone furoatevs. placebo: fluticasone furoate could not only significantly improve trough FEV1 (MD=0.10, 95%CI 0.05 to 0.15,P=0.000 2), but also improve the percentage of rescue-free in 24 hours and the symptom-free periods in 24 hours. Meanwhile, fluticasone furoate could not increase the adverse events rate (OR=1.38, 95%CI 0.28 to 6.77,P=0.69). (2) Fluticasone furoate plus vilanterolvs. fluticasone furoate alone: Compared with fluticasone furoate alone, fluticasone furoate plus vilanterol could significantly improve FEV1 (MD=–0.10, 95%CI –0.19 to –0.01,P=0.02) and 0–24 h wmFEV1 (MD=–0.10, 95%CI –0.19 to –0.01,P=0.02). the combination therapy also had better percentage of rescue-free in 24 hours and symptom-free periods in 24 hours without increasing the rate of adverse events (OR=–1.05, 95%CI –1.39 to –0.80,P=0.72). (3) Fluticasone furoatevs. fluticasone propionate: There were no significant differences between fluticasone furoate and fluticasone propionate in FEV1 (MD=–0.02, 95%CI –0.08 to 0.04,P=0.52), percentage of rescue-free in 24 hours and adverse events rate (OR=1.62, 95%CI 0.77 to 3.40,P=0.20). Conclusion Current evidence shows, fluticasone furoate could effectively improve the lung function and control the symptoms of asthma patients than placebo; fluticasone furoate plus vilanterol shows better effects than fluticasone furoate alone without increasing the adverse event rate. Fluticasone furoate and fluticasone propionate have similar effects, but fluticasone furoate is more convenient and could improve patients’ adherence. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To systematically review the efficacy and safety of umeclidinium/vilanterol in the treatment of chronic obstructive pulmonary disease. Methods PubMed, The Cochrane Library, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) about umeclidinium/vilanterol for chronic obstructive pulmonary disease from inception to March 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results Eight RCTs involving 8 992 patients were included. The results of meta-analysis showed that: (1) umeclidinium/vilanterol vs. placebo: umeclidinium/vilanterol could significantly improve Trough FEV1 (MD=0.20, 95%CI 0.17 to 0.23, P<0.000 01) and the quality of life: TDI score (MD=0.99, 95%CI 0.71 to 1.28,P<0.000 01), SGRQ score (MD=–4.00, 95%CI –5.35 to –2.66,P<0.000 01), SOBDA score (MD=–0.16, 95%CI –0.23 to –0.09,P<0.000 01), and reduce the use of rescue drugs (salbutamol), while not increase the adverse events. (2) umeclidinium/vilanterolvs. fluticasone propionate/salmeterol: UMEC/VI could improve lung function in patients with COPD: Trough FEV1 (MD=0.09, 95%CI 0.07 to 0.11, P<0.000 01), reduce the use of rescue drugs (salbutamol), and had lower adverse events. But there was no significant difference in the quality of life between two groups. (3) umeclidinium/vilanterolvs. single bronchodilator: umeclidinium/vilanterol could significantly improve spirometric parameters: Trough FEV1 (MD=0.08, 95%CI 0.07 to 0.10, P<0.000 01), and the quality of life: TDI score (MD=0.38, 95%CI 0.17 to 0.59,P=0.000 3), SGRQ score (MD=–1.18, 95%CI –2.06 to –0.29, P=0.009). Umeclidinium/vilanterol could significantly reduce the use of rescue drugs (salbutamol) without increasing the adverse events. Conclusion UMEC/VI is superior to placebo in the treatment of COPD patients, which can significantly improve lung function, control symptoms and improve the quality of life, with good safety and tolerance. Compared with salmeterol/fluticacin, UMEC/VI has a significant effect on improving lung function and controlling symptoms without increasing adverse effects, while UMEC/VI is easier to use with better patient compliance. UMEC/VI is superior to bronchodilator alone in improving lung function, controlling symptoms and improving the quality of life without increasing the incidence of adverse events. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.