Systematic review —a tool for the pharmaceutical physician
A meta-analysis of nine large clinical studies that had looked at a clinical dilemma, which option to use at ‘Step 3 of the British Guidelines on Asthma Management’, was conducted to attempt to determine the better option for adult asthma. All studies had reported results demonstrating superiority of the addition of a long-acting bronchodilator to inhaled corticosteroid for lung function, but, taken singly, none of the studies had sufficient power to provide conclusive evidence on the relative effect of either treatment option on the incidence of asthma exacerbations. However, a carefully conducted meta-analysis of the nine studies was able to provide a conclusive answer to this question. The work was further developed after abstract presentation and subsequently published. This article argues that the pharmaceutical physician is well placed to use this statistical tool more often, but still judiciously, to look at the benefit (or risk) of drugs in development or on the market, and then to act upon that information appropriately.
Keywordsasthma exacerbation inhaled corticosteroids long-acting bronchodilator meta-analysis salmeterol
This work was submitted in full to the Faculty of Pharmaceutical Medicine, UK, in March 2001 as a dissertation for full faculty membership. This article represents a summary of the work undertaken and the discussion. The views expressed are those of the author. The author would like to thank Stephen Pyke and Mark Britton for their help with MIASMA and Stuart Dollow, FFPM, for his comments and advice on this article.
- 1.Swales JD. Meta analysis as a guide to clinical practice. J Hypertension 1993; 11 (suppl 5):S59–S63.Google Scholar
- 2.Cochrane AL. Foreword. In: Chalmers I, Enkin M, Keirse MJNC, editors. Effective care in pregnancy and childbirth. Oxford: Oxford University Press; 1989, p. vii.Google Scholar
- 5.Oakley-Browne MA, Adams P, Mobberley PM. Interventions for pathological gambling. Cochrane Database for Syst Rev 2000; CD001521.Google Scholar
- 6.Wilson AJ, Gibson PG, Coughlan J. Long acting beta-agonists versus theophylline for maintenance treatment in asthma. Cochrane Database for Syst Rev 2000; CD001281.Google Scholar
- 7.Ram FSF, Brocklebank DM, White J, Wright J. Pressurised metered dose inhalers versus all other hand-held inhaler devices to deliver beta-2 agonist bronchodilators for non-acute asthma. Cochrane Database for Syst Rev 2000; CD002158.Google Scholar
- 8.Cochrane AL. 1931–1971: a critical review, with particular reference to the medical profession. In: Medicines for the year 2000. London: Office of Health Economics, 1979. pp. 1–11.Google Scholar
- 9.EBM Reviews—Cochrane Database of Systematic Reviews. http://www.cochrane.de/cc/cochraneGoogle Scholar
- 10.Flynn CA, Helwig AL, Meurer LN. Bacterial vaginosis in pregnancy and the risk of prematurity: a meta-analysis. J Fam Prac 1999; 48:897–898.Google Scholar
- 12.Gosden T, Forland F, Kristiansen I, Sutton M, Leese B, Giuffrida A, et al. Capitation, salary, fee for service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Database for Syst Rev 2000; CD002215.Google Scholar
- 13.Marshall M, Lockwood A. Assertive community treatment for people with severe mental disorders. Cochrane Database for Syst Rev 2000; CD001089.Google Scholar
- 14.Thomas L, Cullum N, McColl E, Rousseau N, Soutter J, Steen N. Guidelines in professions allied to medicine. Cochrane Database for Syst Rev 2000; CD000349.Google Scholar
- 15.British guidelines on asthma management. Thorax 1997; 52 (Suppl1):s1–s21.Google Scholar