title: Indacaterol for chronic obstructive pulmonary disease: systematic review and meta-analysis.
abstract: BACKGROUND
  Inhaled bronchodilators are the first-line therapy for COPD. Indacaterol is a novel addition to existing long-acting bronchodilators.
  
  
  OBJECTIVE
  Systematic review of randomized controlled trials (RCT) ON efficacy and safety of indacaterol as compared: 1) with placebo at different dosages, 2) with existing bronchodilators; (3) as add-on treatment to tiotropium.
  
  
  METHODS
  We searched 13 electronic databases, including MEDLINE, EMBASE and CENTRAL, and contacted the manufacturer for unpublished data. Primary outcome was mean FEV1 change at 12(th) week, secondary outcomes included changes in SGRQ, TDI and BODE index at 6 months, exacerbation at 1 year, and worsening of symptoms.
  
  
  RESULTS
  Twelve eligible RCTs of moderate risk of bias included data from 10,977 patients. Compared to placebo, indacaterol improved FEV1 by a weighted mean difference (WMD) of 0.16 L (95%CI: 0.15, 0.18 L, p<0.001), homogeneously above the minimally important difference of 0.10 L. It offered clinically relevant improvement in all secondary outcomes except exacerbation. Magnitude of benefit did not differ significantly by dosage, but one treatment related death was reported at 300 ug. Efficacy of Indacaterol was similar to formoterol and salmeterol (FEV1 WMD = 0.04 L, 95%CI: 0.01 L, 0.07 L, p = 0.02); and tiotropium (FEV1 WMD = 0.01 L, 95%CI: -0.01, 0.03 L, p = 0.61). The use of indacaterol on top of tiotropium yielded additional improvement on FEV1 (WMD = 0.07 L, 95%CI: 0.05 L, 0.10 L, p<0.001).
  
  
  CONCLUSIONS
  Indacaterol is safe and beneficial for patients with COPD at dosage ≤150 ug. It may serve as a good alternative to existing bronchodilators, or as an add-on to tiotropium for unresponsive patients. Use of higher dosage requires further justification.
authors: Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
authors: Vincent C H
authors: VC
authors: Chung
authors: Polly H X
authors: PH
authors: Ma
authors: David S C
authors: DS
authors: Hui
authors: Wilson W S
authors: WW
authors: Tam
authors: Jin Ling
authors: JL
authors: Tang
mesh_terms: D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007189:Indans / Q000009:adverse effects / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D015363:Quinolones / Q000009:adverse effects / Q000627:therapeutic use*; D012602:Scopolamine Derivatives / Q000627:therapeutic use; D000069447:Tiotropium Bromide; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D007189:Indans; D015363:Quinolones; D012602:Scopolamine Derivatives; C510790:indacaterol; D000069447:Tiotropium Bromide
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