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Respiratory Research

, 14:100

First Online: 07 October 2013Received: 14 June 2013Accepted: 25 September 2013


BackgroundClinicians are faced with an increasingly difficult choice regarding the optimal bronchodilator for patients with chronic obstructive pulmonary disease COPD given the number of new treatments. The objective of this study is to evaluate the comparative efficacy of indacaterol 75-150-300 μg once daily OD, glycopyrronium bromide 50 μg OD, tiotropium bromide 18 μg-5 μg OD, salmeterol 50 μg twice daily BID, formoterol 12 μg BID, and placebo for moderate to severe COPD.

MethodsForty 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.

ResultsIndacaterol was associated with a higher trough FEV1 than other active treatments difference for indacaterol 150 μg and 300 μg 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 μg and 300 μg versus placebo: -3.9 95% CrI -5.2 -2.6; -3.6 95% CrI -4.8 -2.3. Glycopyrronium and tiotropium 18 μg 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.

ConclusionIn terms of trough FEV1 and SGRQ score indacaterol, glycopyrronium, and tiotropium are expected to be the most effective bronchodilators.

KeywordsCOPD Bronchodilator Systematic review Meta-analysis Mixed treatment comparison Electronic supplementary materialThe online version of this article doi:10.1186-1465-9921-14-100 contains supplementary material, which is available to authorized users.

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Autor: Shannon Cope - James F Donohue - Jeroen P Jansen - Matthias Kraemer - Gorana Capkun-Niggli - Michael Baldwin - Felicity B


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