(HealthDay News) — For patients with persistent asthma, the use of long-acting muscarinic antagonists (LAMAs) versus placebo as an adjunct to inhaled corticosteroids, and combined use of inhaled corticosteroids and long-acting β-agonists (LABAs), termed single maintenance and reliever therapy (SMART), are associated with a reduced risk of exacerbations, according to two reviews published online March 19 in JAMA.

Diana M. Sobieraj, PharmD, from the University of Connecticut School of Pharmacy in Storrs, and colleagues reviewed the effects associated with LAMA vs placebo vs another controller as an adjunct to inhaled corticosteroids in patients with uncontrolled persistent asthma. Data were included from 15 randomized clinical trials with 7122 patients. The researchers found that the risk of exacerbations requiring systemic corticosteroids was significantly reduced by adding LAMA versus placebo to inhaled corticosteroids (risk ratio, 0.67); there was no significant improvement in the exacerbation risk for adding LAMA vs LABA.

In a second study, Sobieraj and colleagues conducted a review of the effects of SMART in patients with persistent asthma. Data were reviewed from 16 randomized clinical trials with 22,748 patients. The researchers found that SMART correlated with a reduced risk of asthma exacerbations compared with the same or a higher dose of inhaled corticosteroids and LABA as the controller therapy (relative risks, 0.68 and 0.77, respectively).

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“The use of single maintenance and reliever therapy compared with inhaled corticosteroids as the controller therapy (with or without a long-acting β-agonist) and short-acting β-agonists as the relief therapy was associated with a lower risk of asthma exacerbations,” Sobieraj and colleagues write in the second study.


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Reference

  1. Sobieraj DM, Baker WL, Nguyen E, et al. Association of inhaled corticosteroids and long-acting muscarinic antagonists with asthma control in patients with uncontrolled, persistent asthma: A systematic review and meta-analysis. JAMA. 2018 March 19. doi:10.1001/jama.2018.2757 [Epub ahead of print]
  2. Sobieraj DM, Weeda ER, Nguyen E, et al. Association of inhaled corticosteroids and long-acting β-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma: A systematic review and meta-analysis. JAMA.2018 March 19. doi:10.1001/jama.2018.2769 [Epub ahead of print]
  3. Krishnan JA, Au DH. Time to converge FDA decisions and evidence syntheses for long-acting muscarinic antagonists and SMART in guidelines for the treatment of asthma. JAMA. 2018 March 19. doi:10.1001/jama.2018.2029 [Epub ahead of print]