Comparative efficacy of long-acting bronchodilators for COPD - a network meta-analysis

Respiratory Research

Paul Jones³  Alexandra Ellis⁴  Felicity Buckley⁴  Michael Baldwin²  Gorana Capkun-Niggli⁶  Matthias Kraemer⁶  Jeroen P Jansen⁴  James F Donohue¹  Shannon Cope⁵ 

[1] Department of Medicine, University North Carolina, North Carolina, USA;Novartis Horsham Research Centre, Horsham, UK;Division of Clinical Science, St George’s University of London, London SW17 0RE, UK;MAPI Consultancy, Boston, USA;MAPI Consultancy, Toronto, Canada;Novartis Pharma AG, Basel, Switzerland

关键词: Mixed treatment comparison;    Meta-analysis;    Systematic review;    Bronchodilator;    COPD;   

Others  :  792679
DOI  :  10.1186/1465-9921-14-100

 received in 2013-06-14, accepted in 2013-09-25,  发布年份 2013

【 摘 要 】

Background

Clinicians 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.

Methods

Forty 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.

Results

Indacaterol 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).

Conclusion

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

【 授权许可】

   
2013 Cope et al.; licensee BioMed Central Ltd.

【 图 表 】

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