All but two studies were sponsored by pharmaceutical companies, which had varying levels of involvement in study design, conduct, and data analysis. ![]() Included studies had a generally low risk of selection, performance, detection, attrition, and reporting biases. Study participants had an average age of 64 years and percentage predicted FEV 1 of 51.5% (medians of study means). In each study, between 54% and 91% (median 70%) of participants were males. The median number of participants per study was 700. MAIN RESULTS: This review updates the first version of the review, published in 2017, and increases the number of included studies from 11 to 19 (22,354 participants). We used the GRADE framework to rate our certainty of the evidence in each meta-analysis as high, moderate, low or very low. George's Respiratory Questionnaire (SGRQ) total score change from baseline and trough forced expiratory volume in one second (FEV 1). Primary outcomes were: participants with one or more exacerbations of COPD serious adverse events quality of life, as measured by the St. We analysed dichotomous data as odds ratios (ORs), and continuous data as mean differences (MDs), with 95% confidence intervals (CIs) using Review Manager 5. We resolved any discrepancies through discussion. Two review authors independently extracted data and evaluated risk of bias. ![]() We included studies conducted in an outpatient setting and irrespective of blinding. We included parallel or cross-over randomised controlled trials of at least one month's duration, comparing LAMA+LABA and LABA+ICS for stable COPD. The most recent search was run on 10 September 2022. ![]() Two review authors screened the selected articles. We performed an electronic search of the Cochrane Airways Group Specialised Register,, and the World Health Organization Clinical Trials Search Portal, followed by handsearches. To compare the benefits and harms of LAMA+LABA versus LABA+ICS for treatment of people with stable COPD. This systematic review is an update of a Cochrane Review first published in 2017. However, updated international guidance recommends a LAMA plus a LABA (LAMA+LABA). When two classes of medications are required, a LAMA plus an ICS (LABA+ICS) were previously recommended within a single inhaler as the first-line treatment for managing stable COPD in people in high-risk categories. Long-acting beta-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), and inhaled corticosteroids (ICSs) are inhaled medications used to manage chronic obstructive pulmonary disease (COPD).
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