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The wide availability of LAMA/LABA FDCs in the absence of head-to-head comparative pragmatic trials makes difficult the choice of the combination to be used. Therefore, we carried out a systematic review with meta-analysis that incorporated the data from trials lasting at least 3 months to evaluate the effectiveness of LAMA/LABA FDCs for COPD treatment.

METHODS: RCTs were identified searching from different databases of published and unpublished trials. We aimed to assess the influence of LAMA/LABA combinations on trough FEV1, TDI, SGRQ and cardiac safety vs. monocomponents.
RESULTS: Fourteen papers and 1 congress abstract with 23,168 COPD patients (combinations n=10,328, monocomponents n=12,840) were included in this study. Our results showed that all LAMA/LABA combinations were always more effective than the LAMA or LABA alone in terms of the improvement in trough FEV1. Although there was not significant difference among LAMA/LABA combinations, we identified a gradient of effectiveness among the currently available LAMA/LABA FDCs. LAMA/LABA combinations also improved both TDI and SGRQ scores, and did not increase the cardiovascular risk when compared with monocomponents.

CONCLUSIONS: The gradient of effectiveness emerging from this meta-analysis is merely a weak indicator of possible differences between the various LAMA/LABA FDCs. Only direct comparisons will document if a specific LAMA/LABA FDC is better than the other. In the meanwhile, we think it is only proper consider the dual bronchodilation better than a LAMA or a LABA alone, regardless of drugs used.