Intended for healthcare professionals


Maintenance treatment for adults with chronic asthma

BMJ 2014; 348 doi: (Published 15 May 2014) Cite this as: BMJ 2014;348:g3148
  1. Christopher Cates, senior clinical research fellow
  1. 1Population Health Research Institute, St George’s University of London, UK
  1. ccates{at}

Treatment rankings from network meta-analysis can be unreliable when dominated by indirect evidence

Which treatment for asthma is most likely to reduce the risk of exacerbations in adults? In a linked paper, Loymans and colleagues (doi:10.1136/bmj.g3009) seek to address this question using network meta-analysis.1 The authors identified and compared 16 different treatment approaches, using evidence from randomised trials of at least 24 weeks’ duration. The primary outcome was severe exacerbations (leading to admission to hospital, a visit to the emergency department, or a course of oral steroids).

The following is an example of how the network approach works. Loymans and colleagues’ objective was to determine whether combination treatment with a long acting β agonist and a low dose inhaled corticosteroid ranked better or worse than combination treatment with a long acting β agonist and a high dose of inhaled corticosteroid. In figure 2 of their paper showing the network diagram, the authors labelled these approaches, respectively, as COMBI FIX and COMBI FIX H. An inhaler containing a long acting β agonist and a low dose corticosteroid as maintenance and reliever therapy was labelled …

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