Study Compares Efficacy of Inhaled Corticosteroids with Formoterol or SABA versus SABA Alone for Asthma Reliever Therapy

A recent network meta-analysis found that inhaled
corticosteroids combined with formoterol and inhaled corticosteroids combined
with short-acting β agonists were each associated with reduced asthma
exacerbations and improved asthma control compared with short-acting β agonists
alone in asthmatic individuals. The study was published in the journal JAMA Network.

Asthma is a global disease characterized by airway
inflammation and airflow obstruction. Medications like short-acting β agonists
[SABA] and inhaled corticosteroids (ICS) are prescribed to relieve the
symptoms either alone or in combination. Research recommends inhaled
corticosteroids along with formoterol as the preferred reliever over SABA alone
while certain organizations recommend ICS-SABA as the reliever inhaler. As
there is ambiguity in the optimal asthma reliever researchers conducted a
systematic review of various inhaled relievers to compare short-acting β
agonists (SABA) alone with SABA combined with inhaled corticosteroids (ICS) and
with the fast-onset, long-acting β agonist formoterol combined with ICS for
asthma.

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Using data from search engines like the MEDLINE, Embase, and
CENTRAL databases data was extracted without language restrictions. Pairs of
reviewers independently selected randomized clinical trials evaluating (1) SABA
alone, (2) ICS with formoterol, and (3) ICS with SABA (combined or separate
inhalers). Data extraction and bias assessment were done by two reviewers. Outcomes
were synthesized using the Random-effects meta-analyses. The outcomes measured
were Asthma symptom control, asthma-related quality of life, risk of severe
exacerbations, and risk of serious adverse events by using various
questionnaires.

Findings:

  • About 27 randomized clinical trials were
    included.
  • It was found that when compared with SABA alone,
    both ICS-containing relievers were associated with fewer severe exacerbations with
    high certainty.
  • Asthma control was also improved with, both
    ICS-containing relievers when compared with SABA alone with high certainty.
  • There were very few severe exacerbations of
    asthma when an indirect comparison with ICS-SABA, and ICS-formoterol was done
    with moderate certainty.
  • Compared with SABA alone, ICS-formoterol was not
    associated with an increased risk of serious adverse events (high
    certainty), and ICS-SABA was not associated with an increased risk of
    serious adverse events (moderate certainty).
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Thus, the study concluded that inhaled corticosteroids
combined with formoterol and inhaled corticosteroids combined with short-acting
β agonists were each associated with reduced asthma exacerbations and improved
asthma control compared with short-acting β agonists alone in asthmatics.

Further reading: Rayner DG, Ferri DM, Guyatt GH,
et al. Inhaled Reliever Therapies for Asthma: A Systematic Review and
Meta-Analysis. JAMA. Published online October 28, 2024.
doi:10.1001/jama.2024.22700.

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