Comparative efficacy of long-acting β2-agonists as monotherapy for chronic obstructive pulmonary disease: a network meta-analysis.
OBJECTIVE
Long-acting β2-agonists (LABAs) have demonstrated efficacy in patients with COPD in clinical trials. The purpose of this study was to assess the comparative efficacy of all available dosages of all LABA monotherapies using a network meta-analysis.


METHODS
A systematic literature review identified 33 randomized controlled trials of LABA monotherapies (salmeterol 50 μg twice daily [BID]; formoterol 12 μg BID; indacaterol 75, 150, and 300 μg once daily [OD]; olodaterol 5 and 10 μg OD, and vilanterol 25 μg OD). Clinical efficacy was evaluated at 12 and 24 weeks in terms of trough forced expiratory volume in 1 second (FEV1), transition dyspnea index focal score, St George's Respiratory Questionnaire total score, and rate of COPD exacerbations. The relative effectiveness of all LABA monotherapies was estimated by Bayesian network meta-analysis.


RESULTS
At 12 and 24 weeks, indacaterol 300 and 150 μg OD were associated with statistically significant improvement in trough FEV1compared to all other LABA monotherapies; vilanterol 25 μg OD was superior to formoterol 12 μg BID. At 12 weeks, indacaterol 75 μg OD was associated with significant improvement in trough FEV1compared to formoterol 12 μg BID and olodaterol (5 and 10 μg OD); salmeterol 50 μg BID was superior to formoterol 12 μg BID and olodaterol 5 μg OD. Indacaterol 300 μg OD was also associated with significant improvement in transition dyspnea index focal score compared to all other LABAs at 12 or 24 weeks. Indacaterol 150 μg OD had significantly better results in exacerbation rates than olodaterol 5 μg and olodaterol 10 μg OD.


CONCLUSIONS
Indacaterol 300 μg, followed by 150 and 75 μg, were the most effective LABA monotherapies for moderate to severe COPD.
Department of Pulmonary Diseases and Critical Care Medicine, The University of North Carolina, Chapel Hill, NC.
James F
JF
Donohue
Analysis Group, Inc., Los Angeles, CA.
Keith A
KA
Betts
Analysis Group, Inc., Los Angeles, CA.
Ella Xiaoyan
EX
Du
Novartis Pharmaceutical Corporation, East Hanover, NJ, USA.
Pablo
P
Altman
Novartis Pharma AG, Basel, Switzerland.
Pankaj
P
Goyal
Novartis Pharma AG, Basel, Switzerland.
Dorothy L
DL
Keininger
Novartis Pharma AG, Basel, Switzerland.
Jean-Bernard
JB
Gruenberger
Analysis Group, Inc., Boston, MA, USA.
James E
JE
Signorovitch
D006801:Humans; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects; D001499:Bayes Theorem; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D005541:Forced Expiratory Volume; D008168:Lung / Q000187:drug effects / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents
COPD; indacaterol; long-acting β2-agonists; network meta-analysis; systematic literature review