title: Comparative efficacy of aclidinium versus glycopyrronium and tiotropium, as maintenance treatment of moderate to severe COPD patients: a systematic review and network meta-analysis.
abstract: BACKGROUND
  Aclidinium bromide is a new long-acting muscarinic antagonist (LAMA) indicated for maintenance bronchodilator treatment of chronic obstructive pulmonary disease (COPD). The efficacy of aclidinium was compared with tiotropium and glycopyrronium, using a network meta-analysis (NMA) of randomized controlled trials (RCTs) in moderate-to-severe COPD patients.
  
  
  METHODS
  A systematic review was performed to identify RCTs evaluating aclidinium 400 μg twice daily (BID), glycopyrronium 50 μg once daily (OD), tiotropium 18 μg OD, or tiotropium 5 μg OD in adults with moderate-to-severe COPD. The outcomes of interest were: trough forced expiratory volume in 1 second (FEV1); St George's Respiratory Questionnaire (SGRQ) total score and proportion of patients achieving ≥4 unit change; Transition Dyspnea Index (TDI) focal score and proportion of patients achieving ≥1 point change. The results were synthesized by means of a Bayesian NMA.
  
  
  RESULTS
  Twenty-one studies (22,542 patients) were included: aclidinium 400 μg BID (three studies); tiotropium 5 μg OD (three studies); tiotropium 18 μg OD (13 studies); and glycopyrronium 50 μg OD (two studies). Regarding trough FEV1 at 24 weeks, aclidinium demonstrated comparable efficacy to tiotropium 5 μg (difference in change from baseline [CFB]), (0.02 L [95% credible interval CrI -0.05, 0.09]); tiotropium 18 μg (0.02 L [95% CrI -0.05, 0.08]); and glycopyrronium (0.00 L [95% CrI -0.07, 0.07]). Aclidinium resulted in higher improvement in SGRQ score at 24 weeks, compared to tiotropium 5 μg (difference in CFB, -2.44 [95% CrI -4.82, -0.05]); and comparable results to tiotropium 18 μg (-1.80 [95% CrI -4.52, 0.14]) and glycopyrronium (-1.52 [95% CrI -4.08, 1.03]). Improvements in TDI score were comparable for all treatments.
  
  
  CONCLUSIONS
  Maintenance treatment with aclidinium 400 μg BID is expected to produce similar improvements in lung function, health-related quality of life, and dyspnea compared to tiotropium 5 μg OD; tiotropium 18 μg OD; and glycopyrronium 50 μg OD.
authors.affiliation: MAPI Consultancy, AX Houten, The Netherlands. akarabis@mapigroup.com
authors.forename: Andreas
authors.initials: A
authors.lastname: Karabis
authors.forename: Leandro
authors.initials: L
authors.lastname: Lindner
authors.forename: Michelle
authors.initials: M
authors.lastname: Mocarski
authors.forename: Eline
authors.initials: E
authors.lastname: Huisman
authors.forename: Andrew
authors.initials: A
authors.lastname: Greening
mesh_terms: D001499:Bayes Theorem; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005541:Forced Expiratory Volume; D006024:Glycopyrrolate / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D016017:Odds Ratio; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D020127:Recovery of Function; D012602:Scopolamine Derivatives / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D000069447:Tiotropium Bromide; D016896:Treatment Outcome; D014326:Tropanes / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists; D012602:Scopolamine Derivatives; D014326:Tropanes; C542859:aclidinium bromide; D006024:Glycopyrrolate; D000069447:Tiotropium Bromide
keywords: COPD; aclidinium; glycopyrronium; network meta-analysis; systematic review; tiotropium
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