On-Demand Inhaled Corticosteroid and Fast-Acting Beta-2 Agonist Combination Therapy Versus Regular Inhaled Corticosteroid Plus Rescue Bronchodilator in Adults with Mild Asthma: A Network Meta-Analysis

The aim of this study was to assess the non-inferiority of on-demand (OD) inhaled corticosteroid (ICS) and fast-acting beta-2 agonist (FABA) combination therapy. Although regular inhalation of low-dose ICS and OD short-acting beta-2 agonist (REG-ICS+OD-SABA) is said to be effective therapy for mild asthma, we investigated whether OD-ICS/FABA is as effective as REG-ICS+OD-SABA. A network meta-analysis of randomized controlled trials was conducted to examine non-inferiority by comparing the efficacy of NON-REG+OD-ICS/FABA with REG-ICS+OD-SABA for mild asthma. We also assessed the superiority of NON-REG+OD-ICS/FABA to OD-SABA without any regular treatment (NON-REG+OD-SABA). PubMed, the Cochrane library database, and Scopus were searched to identify relevant articles with an outcome measure of the incidence of asthma control. A network meta-analysis was performed and the summary effect size was expressed as the mean difference (MD) with 95% confidence intervals (CIs). The probability of being the best treatment for the outcome and the surface under the cumulative ranking curves were also calculated. Three randomized controlled trials of treatment for mild asthma met the criteria and were included in the study. Non-inferiority of NON-REG+OD-ICS/FABA to REG-ICS+OD-SABA (MD, -0.17; 95% CI, -0.41 to 0.07) and superiority of NON-REG+OD-ICS/FABA to NON-REG+OD-SABA (MD, -0.29; 95% CI, -0.49 to -0.08) were shown in patients with mild asthma. The respective probabilities of being the best treatment for asthma control were 91.2%, 8.8% and 0.2% for NON-REG+OD-ICS/FABA, REG-ICS+OD-SABA, and NON-REG+OD-SABA, respectively, and the surface under the cumulative ranking curves were 1.0, 0.5, and 0.1, respectively. These results suggest that NON-REG+OD-ICS/FABA is an effective alternative to REG-ICS+OD-SABA for asthma control in patients with mild asthma