Efectividad y seguridad de la triple terapia comparada con terapia dual en pacientes con EPOC: revisión sistemática de la literatura y metaanálisis

Abstract

ABSTRACT Title: effectiveness and safety of triple therapy compared with dual therapy in patients with copd: systematic review of the literature and meta-analysis. Introduction: Currently, there is uncertainty about the magnitude of clinical benefit and the identification of patients with the best risk-benefit profile for treatment with triple therapy in COPD patients with dyspnea and exercise intolerance. Objective: To identify the available scientific evidence on the effectiveness and safety of triple therapy with long-acting 2-agonist bronchodilators (LABA) + long-acting muscarinic antagonist (LAMA) + plus inhaled corticosteroids (ICS) compared to dual therapy (LABA-LAMA) in patients with COPD presenting with dyspnea or exercise intolerance. Methods: An update of the systematic review by Manoj et al. 2020 according to the Cochrane methodology, using the PRISMA-P guide was made; the protocol was registered in the PROSPERO database with the ID number: CRD42022336544, using the MEDLINE, EMBASE and CENTRAL databases. Results: Initially, 1213 citations were identified (360 in MEDLINE - PubMed, 621 in EMBASE - Elsevier and 232 in CENTRAL - OVID). Acute exacerbations were evaluated in 6 studies with a rate ratio of 0.74, documenting a 26% reduction in exacerbations. Pneunonia was evaluated in 7 studies with a relative risk of 1.54, with an increase in pneumonia cases of 54%. Mortality was evaluated in 6 studies where a 29% decrease in mortality was found in favor of triple therapy with a relative risk of 0.71 [0.56,