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. 2022 Nov:203:106993.
doi: 10.1016/j.rmed.2022.106993. Epub 2022 Sep 21.

Impact of inhaled fluticasone propionate/salmeterol on health-related quality of life in asthma: A network meta-analysis

Kittipong Maneechotesuwan  1 , Dave Singh  2 , Leandro G Fritscher  3 , Nese Dursunoglu  4 , Abhijith P G  5 , Abhay Phansalkar  6 , Bhumika Aggarwal  7 , Emilio Pizzichini  8 , Justyna Chorazy  9 , Heather Burnett  9
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Free article

Impact of inhaled fluticasone propionate/salmeterol on health-related quality of life in asthma: A network meta-analysis

Kittipong Maneechotesuwan et al. Respir Med. 2022 Nov.
Free article

Abstract

Objective: This network meta-analysis (NMA) compared fixed-dose, twice daily fluticasone propionate/salmeterol (FP/Sal) vs. inhaled corticosteroid (ICS) and other ICS/long-acting beta-agonists (LABA) treatments, including when administered using maintenance and reliever therapy (MART) regimens, in terms of improvements in health-related quality of life (HRQoL). The relationship between changes in asthma control and HRQoL was assessed.

Methods: Articles published between 2001 and 2021, reporting change from baseline (CFB) in Asthma Quality of Life Questionnaire (AQLQ) in patients with moderate-to-severe asthma, were identified by a systematic review. Random effects Bayesian NMAs derived estimates of the mean difference in CFB in AQLQ vs. other interventions connected to the network (included 15 studies). Sensitivity analyses explored the impacts of differences in follow-up duration, baseline asthma control, the inclusion of observational studies, adjusting for baseline FEV1, and low-medium ICS dose arms only. Linear regression analysis compared CFBs in AQLQ and Asthma Control Questionnaire (ACQ) score.

Results: Mean CFB in AQLQ with FP/Sal vs. comparators demonstrated expected ranked effects: mean difference 0.65 [95% credible interval: 0.54, 0.78] versus placebo, 0.58 [ 0.33, 0.84] versus LABA, 0.21 [ 0.13, 0.31] versus ICS alone, 0.06 [-0.04, 0.19] versus other ICS/LABA, and 0.00 [-0.13, 0.14] versus ICS/formoterol MART. Sensitivity analyses largely showed consistent results. Improvements in AQLQ and ACQ were strongly correlated (R = 0.94).

Conclusions: This NMA demonstrates that HRQoL is responsive to treatment, is strongly related to asthma control and that it can be well-managed in patients with moderate-to-severe asthma using regular treatment with inhaled FP/Sal.

Keywords: Asthma quality of life questionnaire; ICS/LABA; Network meta-analysis; Systematic review.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kittipong Maneechotesuwan has received honoraria from Chiesi, GSK, Astra Zeneca, Boehringer Ingeheim, Sanofi, Roche, and Novartis; and has acted as an advisory board consultant for Chiesi, GSK, Astra Zeneca, Boehringer Ingeheim, and Sanofi. Dave Singh has received personal fees from Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, CSL Behring, Epiendo, Genentech, GSK, Glenmark, Gossamerbio, Kinaset, Menarini, Novartis, Pulmatrix, Sanofi, Synairgen, Teva, Theravance and Verona. Leandro Fritscher and Neşe Dursunoğlu declare no conflicts of interest. Abhijith PG, Abhay Phansalkar, Bhumika Aggarwal, Emilio Pizzichini are employees of GSK and hold stocks and shares in GSK. Justyna Chorazy and Heather Burnett are employees of Evidera who conducted the systematic literature review and network meta-analysis, funded by GSK.

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