Published in:
Open Access 01-04-2023 | Umeclidinium | Letter
Letter to the Editor Regarding “Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) Triple Therapy Compared with Other Therapies for the Treatment of COPD: A Network Meta-Analysis”
Published in: Advances in Therapy | Issue 5/2023
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The network meta-analysis (NMA) of Ismaila et al. contains limitations in design and reporting that could strongly influence the validity of the findings and conclusions.
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Heterogeneity between studies was not adequately accounted for; only results from a fixed-effects model are reported, which contradicts guidance on NMA methodology for comparing studies with considerable heterogeneity and can yield misleading results.
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Due to fundamental differences between the FULFIL and KRONOS studies, and a single common comparator that performed differently in the two studies, these should not have been relied upon to establish a network connection to compare fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) and budesonide/glycopyrronium bromide/formoterol fumarate (BUD/GLY/FOR).
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Given these methodological issues and selective reporting of fixed-effects model results, we do not agree with Ismaila et al.’s assertion that FF/UMEC/VI showed statistically significant improvements in the annualized rate of combined moderate/severe exacerbations versus BUD/GLY/FOR.
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The NMA findings and conclusions are not consistent with evidence from four other published NMAs of triple therapies in patients with chronic obstructive pulmonary disease (including two from independent researchers), all of which used random-effects models.
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