OBJECTIVES: To assess the comparative efficacy and safety of inhaled corticosteroids and long-acting beta-agonist (ICS/LABA) fixed doses combination and phosphodiesterase-4 inhibitor for chronic obstructive pulmonary disease (COPD), using a Bayesian network meta-analysis. METHODS: A systematic literature review was conducted according to NICE guidelines. Outcomes of interest included through forced expiratory volume in one second (FEV1), COPD exacerbations and discontinuations due to adverse events (AE). Networks of evidence were based on treatment- and dose-specific nodes except for budesonide/formoterol for which different devices were combined. Interpretation of results was based on absolute differences/ratios and Bayesian probabilities for treatments to perform better than others (P), where P≤15% indicated a smaller effect and P≥85% a larger effect. Vague prior distributions were used. Selection of fixed versus random effects was based on the Deviance Information Criterion (DIC). RESULTS: D) compared to roflumilast (D: 0.050L to 0.060L, P≥94%), ICS/LABA were comparable to each other and all active treatments performed better compared to placebo. In terms of COPD exacerbations, at 26 weeks, active treatments were overall comparable and performed better than placebo. At 52 weeks, salmeterol/fluticasone propionate had lower COPD exacerbation rates than roflumilast (OR: 0.52, P=94%). ICS/LABA were associated with lower discontinuations due to AE rates compared to roflumilast (OR: 0.10 to 0.30, P≥98%). Among ICS/LABA, mometasone furoate/formoterol 200/10µg had a lower rate of discontinuations compared to salmeterol/fluticasone propionate and fluticasone furoate/vilanterol. CONCLUSIONS: This network meta-analysis of treatment in COPD suggested that ICS/LABA were associated with better efficacy and safety compared to roflumilast. However, roflumilast trials mainly focused on Asian patients and more severe populations which may have impacted the treatment effect observed.