Comparative efficacy of long-acting bronchodilators for COPD - a network meta-analysis

Article English OPEN
Cope, Shannon ; Donohue, James F ; Jansen, Jeroen P ; Kraemer, Matthias ; Capkun-Niggli, Gorana ; Baldwin, Michael ; Buckley, Felicity ; Ellis, Alexandra ; Jones, Paul (2013)
  • Publisher: BioMed Central
  • Journal: Respiratory Research, volume 14, issue 1, pages 100-100 (issn: 1465-9921, eissn: 1465-993X)
  • Related identifiers: pmc: PMC4014806, doi: 10.1186/1465-9921-14-100
  • Subject: Mixed treatment comparison | Pulmonary and Respiratory Medicine | Meta-analysis | Systematic review | Research | COPD | Bronchodilator
    mesheuropmc: respiratory tract diseases

Background: Clinicians are faced with an increasingly difficult choice regarding the optimal bronchodilator for\ud patients with chronic obstructive pulmonary disease (COPD) given the number of new treatments. The objective of this study is to evaluate the comparative efficacy of indacaterol 75/150/300 μg once daily (OD), glycopyrronium\ud bromide 50 μg OD, tiotropium bromide 18 μg/5 μg OD, salmeterol 50 μg twice daily (BID), formoterol 12 μg BID,\ud and placebo for moderate to severe COPD.\ud \ud Methods: Forty randomized controlled trials were combined in a Bayesian network meta-analysis. Outcomes of interest were trough and post-dose forced expiratory volume in 1 second (FEV1), St. George’s Respiratory Questionnaire (SGRQ) score and responders (≥4 points), and Transition Dyspnea Index (TDI) score and responders\ud (≥1 point) at 6 months.\ud \ud Results: Indacaterol was associated with a higher trough FEV1 than other active treatments (difference for indacaterol 150 μg and 300 μg versus placebo: 152 mL (95% credible interval (CrI): 126, 179); 160 mL (95% CrI:\ud 133, 187)) and the greatest improvement in SGRQ score (difference for indacaterol 150 μg and 300 μg versus\ud placebo: -3.9 (95% CrI -5.2, -2.6); -3.6 (95% CrI -4.8, -2.3)). Glycopyrronium and tiotropium 18 μg resulted in the\ud next best estimates for both outcomes with minor differences (difference for glycopyrronium versus tiotropium\ud for trough FEV1 and SGRQ: 18 mL (95% CrI: -16, 51); -0.55 (95% CrI: -2.04, 0.92).\ud \ud Conclusion: In terms of trough FEV1 and SGRQ score indacaterol, glycopyrronium, and tiotropium are expected to\ud be the most effective bronchodilators.\ud
  • References (83)
    83 references, page 1 of 9

    1. Global Initiative for Chronic Obstructive Lung Disease (GOLD): global strategy for the diagnosis management and prevention of chronic obstructive pulmonary disease. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013Feb13.pdf.

    2. Jones PW: St. George's Respiratory questionnaire: MCID. COPD 2005, 2:75-79.

    3. Witek TJ Jr, Mahler DA: Minimal important difference of the transition dyspnoea index in a multinational clinical trial. Eur Respir J 2003, 21:267-272.

    4. Firth R, Henley M, Kramer B, Lassen C, Yang W, Owen R: Full clinical study report for study number QAB149B2333: a phase III, 26-week multi-center randomized double-blind, placebo-controlled, parallel-group study to assess the efficacy, safety and tolerability of indacaterol (150 and 300 μg od) in patients with chronic obstructive pulmonary disease. Novartis data on file 2010.

    5. Buhl R, Dunn LJ, Disdier C, Lassen C, Amos C, Henley M, Kramer B: Blinded 12- week comparison of once-daily indacaterol and tiotropium in COPD. Eur Respir J 2011, 38:797-803.

    6. Dahl R, Chung KF, Buhl R, Magnussen H, Nonikov V, Jack D, Bleasdale P, Owen R, Higgins M, Kramer B: L Efficacy of a new once-daily long-acting inhaled beta2-agonist indacaterol versus twice-daily formoterol in COPD. Thorax 2010, 65:473-479.

    7. Donohue JF, Fogarty C, Lötvall J, Mahler DA, Worth H, Yorgancioglu A, Iqbal A, Swales J, Owen R, Higgins M, Kramer B: Once-daily bronchodilators for chronic obstructive pulmonary disease: indacaterol versus tiotropium. Am J Respir Crit Care Med 2010, 182:155-162.

    8. D'Urzo A, Ferguson GT, van Noord JA, Hirata K, Martin C, Horton R, Lu Y, Banerji D, Overend T: Efficacy and safety of once-daily NVA237 in patients with moderate to severe COPD: the GLOW1 trial. Respir Res 2011, 12:156.

    9. Feldman G, Siler T, Prasad N, Jack D, Piggott S, Owen R, Higgins M, Kramer B: Efficacy and safety of indacaterol 150 microg once-daily in COPD: a double-blind, randomised, 12-week study. BMC Pulm Med 2010, 10:1-9.

    10. Kerwin EM, Gotfried MH, Lawrence D, Lassen C, Kramer B: Efficacy and tolerability of indacaterol 75 μg once daily in patients aged ≥40 years with chronic obstructive pulmonary disease: results from 2 double-blind, placebo-controlled 12-week studies. Clin Ther 2011, 33:1974-1984.

  • Related Research Results (1)
  • Metrics
    No metrics available
Share - Bookmark