Once- vs. twice-daily inhaled therapy in asthma: a network meta-analysis

Abstract

Background: Fluticasone furoate (FF)/vilanterol (VI) combination has been recently approved as once-daily therapy for asthma. To date large-scale quantitative synthesis comparing the efficacy of once- vs. twice-daily inhaled therapy in asthma is still lacking. Aims and Objectives: A quantitative synthesis to compare the efficacy of once- vs. twice-daily inhaled therapy in asthma. Methods: A network meta-analysis was performed to compare the efficacy of once- vs. twice-daily therapy with ICS and LABA on the peak expiratory flow (PEF), use of rescue medication, asthma symptoms, and withdrawal from studies due to lack of efficacy (PROSPERO registration: CRD42019124574). Results: Data from 4,354 asthmatic patients were extracted from 6 randomized controlled trials that directly compared once- vs. twice-daily inhaled therapy in asthma. No significant (P>0.05) difference was detected between once-daily and twice-daily therapy with respect to PEF, use of rescue medication, asthma symptoms, and withdrawal from studies due to lack of efficacy. However, the surface under the cumulative ranking curve (SUCRA) analysis showed a general superiority of FF/VI combination once-daily vs. ICS/LABA twice-daily, excluded for the withdrawal from studies due to lack of efficacy. Detailed results of SUCRA analysis are shown in Table 1. Conclusions: FF/VI combination once-daily is as effective as ICS/LABA twice-daily in the treatment of asthma.