Efficacy of indacaterol 75 µg versus fixed-dose combinations of formoterol-budesonide or salmeterol-fluticasone for COPD: a network meta-analysis Full Text
International Journal of COPD, 07/11/2012
Evidence Based Medicine
Cope S et al. – Based on results of a network meta–analysis with and without covariates, indacaterol 75 µg is expected to be at least as efficacious as formoterol and budesonide (FOR/BUD) and comparable with salmeterol and fluticasone (SAL/FP) in terms of lung function. In terms of breathlessness at 12 weeks, the results are inconclusive given the limited data.Methods
- Fifteen randomized, placebo–controlled clinical trials including COPD patients were evaluated: indacaterol 75 µg once daily (n = 2 studies), indacaterol 150 µg once daily (n = 5), indacaterol 300 µg once daily (n = 4), FOR/BUD 9/160 µg twice daily (n = 2), FOR/BUD 9/320 µg twice daily (n = 2), SAL/FP 50/500 µg twice daily (n = 4), and SAL/FP 50/250 µg twice daily (n = 1).
- All trials were analyzed simultaneously using a Bayesian network meta–analysis and relative treatment effects between all regimens were obtained.
- Treatment–by–covariate interactions were included where possible to improve the similarity of the trials.
- Outcomes of interest were trough forced expiratory volume in 1 second (FEV1) and transitional dyspnea index at 12 weeks.
- Based on the results without adjustment for covariates, indacaterol 75 µg resulted in a greater improvement in FEV1 at 12 weeks compared with FOR/BUD 9/160 µg (difference in change from baseline 0.09 L [95% credible interval 0.04–0.13]) and FOR/BUD 9/320 µg (0.07 L [0.03–0.11]) and was comparable with SAL/FP 50/250 µg (0.00 L [–0.07–0.07]) and SAL/FP 50/500 µg (0.01 L [–0.04–0.05]).
- For transitional dyspnea index, data was available only for indacaterol 75 µg versus SAL/FP 50/500 µg (–0.49 points [–1.87–0.89]).