For a network meta-analysis (NMA), researchers examined the effects of fixed-dose, twice-daily fluticasone propionate/salmeterol (FP/Sal) vs. inhaled corticosteroid (ICS) to other ICS/long-acting beta-agonists (LABA) treatments, including those given utilizing maintenance and reliever therapy (MART) regimens, and other ICS/LABA treatments in terms of improvements in health-related quality of life (HRQoL). It was evaluated how changes in asthma management impacted HRQoL.
A systematic review was conducted to find articles that reported change from baseline (CFB) on the Asthma Quality of Life Questionnaire (AQLQ) in individuals with moderate-to-severe asthma. The mean difference in CFB between AQLQ and other network-connected therapies was determined using random effects Bayesian NMAs (included 15 studies). Sensitivity analyses looked at the effects of varying the follow-up time, baseline asthma control, the inclusion of observational studies, correcting for baseline FEV1 and solely using low-medium ICS dosage arms. CFBs in the AQLQ and Asthma Control Questionnaire (ACQ) scores were compared using linear regression analysis.
The mean CFB in the AQLQ with FP/Sal vs. comparators showed the 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/formote Sensitivity studies produced substantially consistent findings. A substantial correlation (R = 0.94) existed between AQLQ and ACQ improvement.
The NMA shows that HRQoL may be effectively controlled in individuals with moderate-to-severe asthma using routine therapy with inhaled FP/Sal. It also showed that HRQoL was sensitive to treatment and was substantially associated with asthma management.