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Network meta-analysis: Doxofylline seems to be the best xanthine for the treatment of COPD

Theophylline can still have a role in the management of stable chronic obstructive pulmonary disease ( COPD ), but its use remains controversial, mainly due to its narrow therapeutic window.

Doxofylline, another xanthine, is an effective bronchodilator and displays a better safety profile than Theophylline.

Researchers have performed a quantitative synthesis to compare the efficacy and safety profile of different xanthines in COPD.
The primary end-point of this meta-analysis was the impact of xanthines on lung function. In addition, the risk of adverse events by normalising data on safety as a function of person-weeks was assessed.

Data obtained from 998 COPD patients were selected from 14 studies and meta-analysed using a network approach.

The combined surface under the cumulative ranking curve ( SUCRA ) analysis of efficacy ( change from baseline in forced expiratory volume in 1 s ) and safety ( risk of adverse events ) showed that Doxofylline was superior to Aminophylline ( comparable efficacy and significantly better safety ), Bamiphylline ( significantly better efficacy and comparable safety ), and Theophylline ( comparable efficacy and significantly better safety ).

Considering the overall efficacy / safety profile of the investigated agents, the results of this quantitative synthesis have suggested that Doxofylline seems to be the best xanthine for the treatment of COPD. ( Xagena )

Cazzola M et al, Eur Respir Rev 2018; 27(148):180010. doi: 10.1183/16000617.0010-2018.