論文No2529
SMART and as-needed therapies in mild-to-severe asthma: a network meta-analysis
Paola Rogliani, Beatrice Ludovica Ritondo, Josuel Ora, Mario Cazzola, Luigino Calzetta
European Respiratory Journal 56 (3) 2000625; DOI: 10.1183/13993003.00625-2020 Published 10 September 2020
今まで、喘息においてas-needed治療（the single maintenance and reliever therapy (known as “SMART” or “MART”) や必要時にICS/LABAを独占的に使用する方法を含む）を比較したネットワークメタ解析はない。
我々は喘息においてSMARTやas-needed治療の有効性、安全性に関するシステマティックレビューとネットワークメタ解析を行った。
21の論文から32096名の喘息患者を抽出し、6-12か月継続した。
成人の軽症～中等症の喘息患者では低用量SMARTとICS/LABAのas-needed低用量治療は、
他のas-needed治療よりも喘息増悪リスクを減少に有用であった(relative effect <0.78; p<0.05)。
surface under the cumulative ranking curve analysis(SUCRA)の最初の四分位範囲の治療オプションにランクされた。
成人の中等症～重症の喘息患者では、低～中用量SMARTと高用量ICS/LABA + as-needed SABAは
重症喘息増悪のリスク減少に同等に有効であった(p>0.05)。
しかし、低～中用量SMARTのみが最初の治療オプション(SUCRAの最初の四分位範囲)にランクされた。
全体的にこれらの治療の忍容性は高く、効果は肺機能や疾患コントロールにも及んだ。
SMARTやas-needed治療は喘息の最適な治療オプションであり、疾患重症度に応じて投与量を調整することができる。
To date, there are no network meta-analyses comparing the impact of as-needed treatments in asthma, including the single maintenance and reliever therapy (known as “SMART” or “MART”; for simplicity, SMART will be used hereafter) and the use of inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination exclusively on an as-needed basis. Therefore, we performed a systematic review and network meta-analysis concerning the efficacy and safety of SMART and as-needed therapies in asthma. Data from 32 096 asthmatic patients were extracted from 21 studies, lasting from 6 to 12 months. In adult mild-to-moderate asthmatic patients low-dose SMART and as-needed low-dose ICS/LABA combination were significantly (relative effect <0.78; p<0.05) more effective than the other as-needed therapies in reducing the risk of exacerbation, and both were ranked as the first treatment option reaching the first quartile of the surface under the cumulative ranking curve analysis (SUCRA). In adult moderate-to-severe asthmatic patients, low-dose to medium-dose SMART and high-dose ICS/LABA+as-needed short-acting β2-agonist were equally effective in reducing the risk of severe asthma exacerbation (p>0.05), although only low- to medium-dose SMART was ranked as the first treatment option (first SUCRA quartile). Overall, these treatments were well tolerated, and effective also on lung function and disease control. This study supports SMART and as-needed therapies as a suitable therapeutic option for asthma, by providing the most effective positioning of each specific treatment according to the disease severity.