TY  - JOUR
T1  - Long-acting β2-agonist step-off in patients with controlled asthma: Systematic review with meta-analysis
AU  - Brozek JL, Kraft M, Krishnan JA, et al
Y1  - 2012/10/08
N1  - 10.1001/archinternmed.2012.3250
JO  - Archives of Internal Medicine
SP  - 1365
EP  - 1375
VL  - 172
IS  - 18
N2  - Background 
                  Because of concerns about the safety of long-acting β2-agonist (LABA) use in patients with asthma, withdrawal of the LABA is recommended by the US Food and Drug Administration once asthma is controlled by combination therapy with a LABA and inhaled corticosteroid (ICS).Objective 
                  To perform a systematic review and meta-analysis assessing evidence supporting the discontinuation of LABA therapy once asthma control has been achieved with a combination of ICS and LABA.Data Sources 
                  MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched (through August 2010), references of identified studies and selected narrative review articles were evaluated, registries of clinical trials were reviewed, and manufacturers of LABAs were contacted.Study Selection 
                  Randomized controlled trials of discontinuation of LABA therapy in patients with asthma controlled with a combination of ICS and LABA.Data Extraction 
                  Two reviewers independently screened each title and abstract in the initial searches and then the full text of each nominated article to extract data for analyses.Results 
                  Of 1492 screened articles, only 5 trials involving patients aged 15 years or older fulfilled a priori–specified inclusion criteria. Results did not favor the LABA step-off approach compared with no change in treatment. The LABA step-off regimen increased asthma impairment, with worse Asthma Quality of Life Questionnaire score (mean difference [95% CI], 0.32 [0.14-0.51] points lower); worse Asthma Control Questionnaire score (0.24 [0.13-0.35] points higher); fewer symptom-free days (9.15% [1.62%-16.69%] less); and greater risk of withdrawal from study resulting from lack of efficacy or loss of asthma control (risk ratio, 3.27 [2.16-4.96]). Risk of exacerbations and deaths after LABA step-off were not evaluable because of the small number of events and short duration of follow-up.Conclusions 
                  Evidence suggests that discontinuing LABA therapy in adults and older children with asthma controlled with a combination of ICSs and LABAs results in increased asthma-associated impairment. Additional trials measuring all long-term patient-important outcomes are needed.
SN  - 0003-9926
M3  - doi: 10.1001/archinternmed.2012.3250
UR  - http://dx.doi.org/10.1001/archinternmed.2012.3250
ER  -