Comparison of clinical efficacy and safety between indacaterol and tiotropium in COPD: meta-analysis of randomized controlled trials.

Abstract

Two once-daily inhaled bronchodilators, indacaterol and tiotropium, are widely used as first-line therapy in stable COPD patients. This study was performed to compare the clinical efficacy and safety between indacaterol and tiotropium in patients with moderate-to-severe COPD. MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched to identify all published randomized controlled trials (RCTs). The primary outcome was trough forced expiratory volume in 1 second (FEV1) at week 12. Four RCTs were eligible for inclusion (three RCTs with moderate-to-severe COPD patients and one RCT with only severe COPD patients). Trough FEV₁ at weeks 12 and 26 were not significantly different between indacaterol and tiotropium by the standardized mean difference with 0.014 (95% CI, -0.036, 0.063, I²= 23.5%) and with 0.037 (95% CI, -0.059 to 0.133, I²= 0%) along with differences in means of 0.003L and 0.014L, respectively. Indacaterol and tiotropium also showed similar St. George's Respiratory Questionnaire (SGRQ) total scores and percentages of patients with SGRQ improvement (≥ 4 units) at week 26. The incidences of nasopharyngitis, serious cardiovascular events, and serious adverse events were not different between indacaterol and tiotropium, while those of cough (OR = 1.68, P < 0.001, and RR = 1.63) and COPD worsening (OR = 1.18, P = 0.003, and RR = 1.12) were higher for indacaterol than tiotropium. However, when one study with only severe COPD patients was removed from the meta-analysis, the difference in the incidence of COPD worsening between indacaterol and tiotropium became non-significant (OR = 1.13, P = 0.204, and RR = 1.09). The clinical efficacy and serious adverse events between indacaterol and tiotropium were equivocal in patients with moderate-to-severe COPD. Cough is a common complaint associated with indacaterol, and COPD worsening needs to be carefully monitored in severe COPD patients when treated with indacaterol.

• Authors: Jung Soo Kim, Jinkyeong Park, Seong Yong Lim, Yeon-Mok Oh, Kwang Ha Yoo, Yong Bum Park, Seung Soo Sheen, Min-Ji Kim, K C Carriere, Ji Ye Jung, Hye Yun Park
• Journal: PloS one (PLoS One) Vol. 10 Issue 3 Pg. e0119948 ( 2015) ISSN: 1932-6203 [Electronic] United States
• PMID: 25799171 (Publication Type: Comparative Study, Journal Article, Meta-Analysis)

Chemical References

• Adrenergic beta-2 Receptor Agonists
• Bronchodilator Agents
• Indans
• Quinolones
• indacaterol
• Tiotropium Bromide

Topics

• Adrenergic beta-2 Receptor Agonists (therapeutic use)
• Bronchodilator Agents (therapeutic use)
• Forced Expiratory Volume (drug effects)
• Humans
• Indans (therapeutic use)
• Pulmonary Disease, Chronic Obstructive (drug therapy)
• Quinolones (therapeutic use)
• Randomized Controlled Trials as Topic
• Tiotropium Bromide (therapeutic use)
• Treatment Outcome