Benefits of adding fluticasone propionate/salmeterol to tiotropium in COPD: A meta-analysis

Objective This meta-analysis was performed to evaluate the efficacy and safety of adding fluticasone propionate/salmeterol (FSC) to tiotropium (Tio) in COPD patients. Methods A systematic search was made of MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases, and a hand search of leading respiratory journals. Randomized clinical trials on treatment of stable COPD with the addition of FSC, compared with tiotropium alone, were reviewed. Studies were pooled to odds ratio (OR) and weighted mean differences (WMD), with 95% confidence interval (CI). Results Six trials met the inclusion criteria. Compared with tiotropium, addition of FSC presented significant effects on trough forced expiratory volume in 1 s (FEV₁) (WMD 54.64 mL; 95% CI 51.76 to 57.52 mL; P < 0.001), COPD exacerbations (OR 0.73; 95% CI 0.55 to 0.96; p = 0.03), and health-related quality of life (WMD 4.63; 95% CI 4.26 to 5.01; P < 0.001). No significant increase was noticed in adverse events in the Tio + FSC group (OR 1.24; 95% CI 0.98 to 1.57; p = 0.07). Conclusions The addition of FSC to subjects with COPD treated with tiotropium significantly improves lung function, quality of life and COPD exacerbations without increasing the risk of adverse events.