Background: Increasing evidence suggests pharmacological treatments may impact on overall survival in Chronic\nObstructive Pulmonary Disease (COPD) patients. Individual clinical trials are rarely powered to detect mortality\ndifferences between treatments and may not include all treatment options relevant to healthcare decision makers.\nMethods: A systematic review was conducted to identify RCTs of COPD treatments reporting mortality; evidence\nwas synthesised using network meta-analysis (NMA). The analysis included 40 RCTs; a quantitative indirect comparison\nbetween 14 treatments using data from 55,220 patients was conducted.\nResults: The analysis reported two treatments reducing all-cause mortality; salmeterol/fluticasone propionate\ncombination (SFC) was associated with a reduction in mortality versus placebo in the fixed effects (HR 0.79;\n95 % Crl 0.67, 0.94) but not the random effects model (0.79; 0.56, 1.09). Indacaterol was associated with a\nreduction in mortality versus placebo in fixed (0.28; 0.08 to 0.85) and random effects (0.29; 0.08, 0.89) models.\nMean estimates and credible intervals for hazard ratios for indacaterol versus placebo are based on a small\nnumber of events; estimates may change when the results of future studies are included. These results were\nmaintained across a variety of assumptions and provide evidence that SFC and indacaterol may lead to\nimproved survival in COPD patients.\nConclusion: Results of an NMA of COPD treatments suggest that SFC and indacaterol may reduce mortality.\nFurther research is warranted to strengthen this conclusion.
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