Cividini, Sofia, Sinha, Ian, Donegan, Sarah 
ORCID: 0000-0003-1709-2290, Maden, Michelle ORCID: 0000-0003-4419-6343, Rose, Katie, Fulton, Olivia, Culeddu, Giovanna, Hughes, Dyfrig A ORCID: 0000-0001-8247-7459, Turner, Stephen, Tudur Smith, Catrin ORCID: 0000-0003-3051-1445 et al (show 1 more authors)
(2023)
Best step-up treatments for children with uncontrolled asthma: A systematic review and network meta-analysis of individual participant data.
The European respiratory journal, 62 (6).
p. 2301011.
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13993003.01011-2023.full.pdf - Author Accepted Manuscript Available under License Creative Commons Attribution. Download (16MB) | Preview |
Abstract
<h4>Introduction</h4>There is uncertainty about the best treatment option for children/adolescents with uncontrolled asthma despite inhaled corticosteroids, and international guidelines make different recommendations.<h4>Objectives</h4>We evaluated the pharmacological treatments to reduce asthma exacerbations and symptoms in uncontrolled patients <18 years on inhaled corticosteroids.<h4>Methods</h4>We searched MEDLINE, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Embase, the Web of Science platform, NICE Technology Appraisals, the NIHR HTA series, the WHO International Clinical Trials Registry Platform, conference abstracts and internal clinical trial registers (1 July 2014 to 5 May 2023) for randomised controlled trials of participants <18 with uncontrolled asthma on any inhaled corticosteroid (ICS) dose alone at screening. Studies before July 2014 were retrieved from previous systematic reviews/contact with authors. Patients had to be randomised to any dose of ICS alone or combined with long-acting β<sub>2</sub>-agonists (LABAs) or combined with leukotriene receptor antagonists (LTRAs); LTRAs alone; theophylline; placebo. Primary outcomes were exacerbation and asthma control. The interventions evaluated were ICS (Low/Medium/High dose); ICS+LABA; ICS+LTRA; LTRA alone; theophylline; placebo.<h4>Results</h4>Of the 4708 publications identified, 144 trials were eligible. Individual participant data were obtained from 29 trials, and aggregate data from 19 trials. Compared to ICS Low, ICS Medium+LABA was associated with the lowest odds of exacerbation (OR 0.44 [95% CrI 0.19-0.90]) and with an increased FEV<sub>1</sub> (MD 0.71 [95% CrI 0.35-1.06]). Treatment with LTRA was the least preferred. No apparent differences were found for asthma control.<h4>Conclusion</h4>Uncontrolled children/adolescents on low-dose ICS should be recommended a change to medium-dose ICS+LABA to reduce the risk for exacerbation and improve lung function.Using medium-dose inhaled corticosteroids with long-acting β<sub>2</sub>-agonists reduces the odds of exacerbation and increases FEV<sub>1</sub> in patients 6 to 17 years whose asthma is uncontrolled on a low dose of inhaled corticosteroids alone.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | PhD on behalf of the EINSTEIN collaborative group |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 21 Nov 2023 10:19 |
| Last Modified: | 30 Dec 2023 01:30 |
| DOI: | 10.1183/13993003.01011-2023 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3176896 |
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