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BMC Pulmonary Medicine
Published in: BMC Pulmonary Medicine 1/2012

Open Access 01-12-2012 | Research article

A systematic review with attempted network meta-analysis of asthma therapy recommended for five to eighteen year olds in GINA steps three and four

Authors: Lonneke B van der Mark, PH Edo Lyklema, Ronald B Geskus, Jacob Mohrs, Patrick JE Bindels, Wim MC van Aalderen, Gerben ter Riet

Published in: BMC Pulmonary Medicine | Issue 1/2012

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Abstract

Background

The recommendations for the treatment of moderate persistent asthma in the Global Initiative for Asthma (GINA) guidelines for paediatric asthma are mainly based on scientific evidence extrapolated from studies in adults or on consensus. Furthermore, clinical decision-making would benefit from formal ranking of treatments in terms of effectiveness.
Our objective is to assess all randomized trial-based evidence specifically pertaining to 5-18 year olds with moderate persistent asthma. Rank the different drug treatments of GINA guideline steps 3&4 in terms of effectiveness.

Methods

Systematic review with network meta-analysis. After a comprehensive search in Central, Medline, Embase, CINAHL and the WHO search portal two reviewers selected RCTs performed in 4,129 children from 5-18 year old, with moderate persistent asthma comparing any GINA step 3&4 medication options. Further quality was assessed according the Cochrane Collaboration’s tool and data-extracted included papers and built a network of the trials. Attempt at ranking treatments with formal statistical methods employing direct and indirect (e.g. through placebo) connections between all treatments.

Results

8,175 references were screened; 23 randomized trials (RCT), comparing head-to-head (n=17) or against placebo (n=10), met the inclusion criteria. Except for theophylline as add-on therapy in step 4, a closed network allowed all comparisons to be made, either directly or indirectly. Huge variation in, and incomplete reporting of, outcome measurements across RCTs precluded assessment of relative efficacies.

Conclusion

Evidence-based ranking of effectiveness of drug treatments in GINA steps 3&4 is not possible yet. Existing initiatives for harmonization of outcome measurements in asthma trials need urgent implementation.
Appendix
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Metadata
Title
A systematic review with attempted network meta-analysis of asthma therapy recommended for five to eighteen year olds in GINA steps three and four
Authors
Lonneke B van der Mark
PH Edo Lyklema
Ronald B Geskus
Jacob Mohrs
Patrick JE Bindels
Wim MC van Aalderen
Gerben ter Riet
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2012
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/1471-2466-12-63

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Keynote webinar | Spotlight on medication adherence

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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