TY - JOUR T1 - ICS-formoterol reliever <em>versus</em> ICS and short-acting β<sub>2</sub>-agonist reliever in asthma: a systematic review and meta-analysis JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00701-2020 VL - 7 IS - 1 SP - 00701-2020 AU - Lee Hatter AU - Pepa Bruce AU - Irene Braithwaite AU - Mark Holliday AU - James Fingleton AU - Mark Weatherall AU - Richard Beasley Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/7/1/00701-2020.abstract N2 - Background The Global Initiative for Asthma recommends as-needed inhaled corticosteroid (ICS)-formoterol as an alternative to maintenance ICS plus short-acting β2-agonist (SABA) reliever at step 2 of its stepwise treatment algorithm. Our aim was to assess the efficacy and safety of these two treatment regimens, with a focus on prevention of severe exacerbation.Methods We performed a systematic review and meta-analysis of all randomised controlled trials (RCTs) comparing as-needed ICS-formoterol with maintenance ICS plus SABA. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Clinicaltrials.gov were searched from database inception to 12 December 2019. The primary outcome was time to first severe exacerbation. RCTs were excluded if they used as-needed budesonide-formoterol as part of a maintenance and reliever regimen, or did not report on severe exacerbations. The review is registered with PROSPERO (identifier number CRD42020154680).Results Four RCTs (n=8065 participants) were included in the analysis. As-needed ICS-formoterol was associated with a prolonged time to first severe exacerbation (hazard ratio 0.85, 95% CI 0.73–1.00; p=0.048) and reduced daily ICS dose (mean difference −177.3 μg, 95% CI −182.2–−172.4 μg). Asthma symptom control was worse in the as-needed group (Asthma Control Questionnaire-5 mean difference 0.12, 95% CI 0.09–0.14), although this did not meet the minimal clinically important difference of 0.50 units. There was no significant difference in serious adverse events (OR 1.07, 95% CI 0.84–1.36).Conclusion As-needed ICS-formoterol offers a therapeutic alternative to maintenance low-dose ICS plus SABA in asthma and may be the preferred option when prevention of severe exacerbation is the primary aim of treatment.As-needed low-dose ICS-formoterol prolongs time to first severe asthma exacerbation compared to maintenance ICS/SABA reliever and represents an alternative for patients, particularly when severe exacerbation prevention is the primary treatment aim https://bit.ly/3mpHVKc ER -