The Therapeutic Index as Indicated by Efficacy/Safety Ratio May Be Primarily Assessed by Meta-Analysis of the Efficacy of ICS Combination Therapy for COPD [Letter]

This is the authors' abstract. We don't add key points for this paper.

of the International Journal of Chronic Obstructive Pulmonary Disease (COPD). They performed a systematic literature review and metaanalysis of randomized clinical trials (RCTs) comparing the effect of inhaled corticosteroid (ICS)-containing combination therapy and non-ICS regimen in patients with COPD. The authors have found that a wide range of patients with COPD could benefit from dual and triple ICS-containing therapy. In addition to the significant reduction of acute exacerbation by ICS-containing therapy, a significant improvement in lung function was observed for ICS/long-acting 2 agonists (LABA) versus LABA and ICS/LABA/long-acting anti-muscarinic agents (LAMA) versus LAMA regimens. A significant improvement in quality of life (QoL) was also observed with ICS versus non-ICS therapy. However, the treatment-emergent adverse events were not fully demonstrated. The increased risk of pneumonia following inhaled steroids and ICS-containing combination therapy for COPD is concerning. In Japanese population data, a significant increase in pneumonia events with ICS/LAMA/LABA treatment compared to with LAMA/LABA treatment has also been reported (OR, 3.38; 95% CI, 1.58 to 7.22; P = 0.002; I2 = 0%). This safety issue of ICS-containing triple therapy is very important for treatment decisions in COPD and should be summarized in the abstract of the current review paper. Although there are some discussions about the pneumonia risk issue in the body of the text, no data is available in the results section of their abstract.