Decline of COPD exacerbations in clinical trials over two decades - a systematic review and meta-regression.
COPD
COPD exacerbations
Inhaled glucocorticosteroids
Meta-analysis
Journal
Respiratory research
ISSN: 1465-993X
Titre abrégé: Respir Res
Pays: England
ID NLM: 101090633
Informations de publication
Date de publication:
16 Aug 2019
16 Aug 2019
Historique:
received:
06
06
2019
accepted:
12
08
2019
entrez:
18
8
2019
pubmed:
20
8
2019
medline:
6
2
2020
Statut:
epublish
Résumé
An important goal of chronic obstructive pulmonary disease (COPD) treatment is to reduce the frequency of exacerbations. Some observations suggest a decline in exacerbation rates in clinical trials over time. A more systematic understanding would help to improve the design and interpretation of COPD trials. We performed a systematic review and meta-regression of the placebo groups in published randomized controlled trials reporting exacerbations as an outcome. A Bayesian negative binomial model was developed to accommodate results that are reported in different formats; results are reported with credible intervals (CI) and posterior tail probabilities (p Of 1114 studies identified by our search, 55 were ultimately included. Exacerbation rates decreased by 6.7% (95% CI (4.4, 9.0); p In conclusion, this meta-regression indicates that the rate of COPD exacerbations decreased over the past two decades to a clinically relevant extent independent of important prognostic factors. This suggests that care is needed in the design of new trials or when comparing results from older trials with more recent ones. Also a considerable effect of adjunct therapy on COPD exacerbations can be assumed. PROSPERO 2018 CRD4218118823.
Sections du résumé
BACKGROUND
BACKGROUND
An important goal of chronic obstructive pulmonary disease (COPD) treatment is to reduce the frequency of exacerbations. Some observations suggest a decline in exacerbation rates in clinical trials over time. A more systematic understanding would help to improve the design and interpretation of COPD trials.
METHODS
METHODS
We performed a systematic review and meta-regression of the placebo groups in published randomized controlled trials reporting exacerbations as an outcome. A Bayesian negative binomial model was developed to accommodate results that are reported in different formats; results are reported with credible intervals (CI) and posterior tail probabilities (p
RESULTS
RESULTS
Of 1114 studies identified by our search, 55 were ultimately included. Exacerbation rates decreased by 6.7% (95% CI (4.4, 9.0); p
CONCLUSIONS
CONCLUSIONS
In conclusion, this meta-regression indicates that the rate of COPD exacerbations decreased over the past two decades to a clinically relevant extent independent of important prognostic factors. This suggests that care is needed in the design of new trials or when comparing results from older trials with more recent ones. Also a considerable effect of adjunct therapy on COPD exacerbations can be assumed.
REGISTRATION
BACKGROUND
PROSPERO 2018 CRD4218118823.
Identifiants
pubmed: 31420040
doi: 10.1186/s12931-019-1163-2
pii: 10.1186/s12931-019-1163-2
pmc: PMC6697937
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
186Subventions
Organisme : Stiftung Oskar-Helene-Heim
ID : Oskar und Helene Medizinpreis 2010
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