Dual LAMA/LABA or triple therapy may raise CV risk among COPD patients

CHINA: According to a research reported in The European Respiratory Journal, dual LAMA/LABA or triple therapy elevates cardiovascular risk in COPD patients compared to ICS/LABA.

A series of long-term lung diseases that impair breathing are collectively referred to as chronic obstructive pulmonary disease (COPD). Chronic bronchitis and emphysema are both components of COPD. COPD sufferers may benefit from medication with long-acting muscarinic receptor antagonists (LAMA). Long-acting muscarinic antagonist/long-acting 2 agonist (LAMA/LABA) combination therapy dramatically improves clinical symptoms, overall health, and lowers the risk of severity in patients with chronic obstructive pulmonary disease, according to high-quality data from randomized controlled trials (RCTs). Nevertheless, there is rising concern that LAMA/LABA medication could make COPD patients more susceptible to cardiovascular illness.

The purpose of this study was to examine whether LAMA/LABA combination medication affects COPD patients' risk of cardiovascular disease.

For this objective, 51 RCTs with 91,021 participants were examined. To find pertinent RCTs of LAMA/LABA or LABA/LAMA/inhaled corticosteroids (ICS) for the therapy of patients with COPD that documented cardiovascular outcomes, two reviewers separately searched EMBASE, PubMed, and the Cochrane Library. MACE (major adverse cardiovascular events), which included cardiovascular death, myocardial infarction (MI), and stroke, was the main result.

Conclusive points of the research:

• In comparison to ICS/LABA, the risks of MACE were considerably higher with dual LAMA/LABA (1.6% against 1.3%; RR, 1.42, 95% CI, 1.11-1.81) and triple treatment (1.6% versus 1.4%; RR, 1.29, 95% CI, 1.03-1.61).
• The RCTs where the average underlying baseline hazard for MACE was >1%/year showed the largest elevated risk.
• Dual LAMA/LABA therapy did not raise the risk of MACE when compared to LAMA only, LABA only, or placebo, though these comparisons might not have had enough statistical power.

The authors came to the conclusion that these results should be taken into account in light of the incremental benefits of these medications on COPD patients' symptoms and exacerbation rates, particularly in those with a MACE risk of >1%/year.

REFERENCE

Mingjin Yang, Yishi Li, Youfan Jiang, Shuliang Guo, Jian-Qing He, Don D Sin, Combination therapy with long-acting bronchodilators and the risk of major adverse cardiovascular events in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis,European Respiratory Journal Jan 2022, 2200302; DOI: 10.1183/13993003.00302-2022