Shannon Cope, James F Donohue, Jeroen P Jansen, Matthias Kraemer, Gorana Capkun-Niggli, Michael Baldwin, Felicity Buckley, Alexandra Ellis and Paul Jones
Respiratory Research 2013, 14:100 doi:10.1186/1465-9921-14-100
Published: 7 October 2013Abstract (provisional)
Background
Clinicians are faced with an increasingly difficult choice regarding the optimal bronchodilator for patients with chronic obstructive pulmonary disease (COPD) given then number of new treatments (COPD). The objective of this study is to evaluate the comparative efficacy of indacaterol 75/150/300 mug once daily (OD), glycopyrronium bromide 50 mug OD, tiotropium bromide 18 mug/5 mug OD, salmeterol 50 mug twice daily (BID), formoterol 12 mug BID, and placebo for moderate to severe COPD.
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 (>=1 point) at 6 months.
Results
Indacaterol was associated with a higher trough FEV1 than other active treatments (difference for indacaterol 150 mug and 300 mug versus placebo: 152 mL (95% credible interval (CrI): 126, 179); 160 mL (95%CrI: 133, 187)) and the greatest improvement in SGRQ score (difference for indacaterol 150 mug and 300 mug versus placebo: -3.9 (95% CrI -5.2, -2.6); -3.6 (95% CrI -4.8, -2.3)). Glycopyrronium and tiotropium 18 mug resulted in the next best estimates for both outcomes with minor differences (difference for glycopyrronium versus tiotropium for trough FEV1 and SGRQ: 18 mL (95%CrI: -16, 51); -0.55 (95%CrI: -2.04, 0.92).
Conclusion
In terms of trough FEV1 and SGRQ score indacaterol, glycopyrronium, and tiotropium are expected to be the most effective bronchodilators.
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