Mortality and drug therapy in patients with chronic obstructive pulmonary disease: a network meta-analysis

BMC Pulm Med. 2015 Nov 11;15:145. doi: 10.1186/s12890-015-0138-4.


Background: Increasing evidence suggests pharmacological treatments may impact on overall survival in Chronic Obstructive Pulmonary Disease (COPD) patients. Individual clinical trials are rarely powered to detect mortality differences between treatments and may not include all treatment options relevant to healthcare decision makers.

Methods: A systematic review was conducted to identify RCTs of COPD treatments reporting mortality; evidence was synthesised using network meta-analysis (NMA). The analysis included 40 RCTs; a quantitative indirect comparison between 14 treatments using data from 55,220 patients was conducted.

Results: The analysis reported two treatments reducing all-cause mortality; salmeterol/fluticasone propionate combination (SFC) was associated with a reduction in mortality versus placebo in the fixed effects (HR 0.79; 95 % Crl 0.67, 0.94) but not the random effects model (0.79; 0.56, 1.09). Indacaterol was associated with a reduction in mortality versus placebo in fixed (0.28; 0.08 to 0.85) and random effects (0.29; 0.08, 0.89) models. Mean estimates and credible intervals for hazard ratios for indacaterol versus placebo are based on a small number of events; estimates may change when the results of future studies are included. These results were maintained across a variety of assumptions and provide evidence that SFC and indacaterol may lead to improved survival in COPD patients.

Conclusion: Results of an NMA of COPD treatments suggest that SFC and indacaterol may reduce mortality. Further research is warranted to strengthen this conclusion.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Albuterol / therapeutic use
  • Aminopyridines / therapeutic use
  • Beclomethasone / therapeutic use
  • Benzamides / therapeutic use
  • Benzyl Alcohols / therapeutic use
  • Bronchodilator Agents / therapeutic use*
  • Budesonide / therapeutic use
  • Chlorobenzenes / therapeutic use
  • Cyclopropanes / therapeutic use
  • Fluticasone-Salmeterol Drug Combination / therapeutic use
  • Formoterol Fumarate / therapeutic use
  • Glucocorticoids / therapeutic use*
  • Humans
  • Indans / therapeutic use
  • Ipratropium / therapeutic use
  • Proportional Hazards Models
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Quinolones / therapeutic use
  • Survival Rate
  • Theophylline / therapeutic use
  • Tiotropium Bromide / therapeutic use
  • Triamcinolone / therapeutic use


  • Aminopyridines
  • Benzamides
  • Benzyl Alcohols
  • Bronchodilator Agents
  • Chlorobenzenes
  • Cyclopropanes
  • Fluticasone-Salmeterol Drug Combination
  • Glucocorticoids
  • Indans
  • Quinolones
  • vilanterol
  • Roflumilast
  • Triamcinolone
  • Budesonide
  • indacaterol
  • Theophylline
  • Ipratropium
  • Beclomethasone
  • Albuterol
  • Formoterol Fumarate
  • Tiotropium Bromide