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

Cope, S; Donohue, JF; Jansen, JP; Kraemer, M; Capkun-Niggli, G; Baldwin, M; Buckley, F; Ellis, A; Jones, P (2013) Comparative efficacy of long-acting bronchodilators for COPD - a network meta-analysis. RESPIRATORY RESEARCH, 14 (100). ISSN 1465-993X https://doi.org/10.1186/1465-9921-14-100
SGUL Authors: Jones, Paul Wyatt

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Abstract

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.

Item Type: Article
Additional Information: © 2013 Cope et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Albuterol, Bayes Theorem, Bronchodilator Agents, Delayed-Action Preparations, Dose-Response Relationship, Drug, Ethanolamines, Glycopyrrolate, Humans, Indans, Pulmonary Disease, Chronic Obstructive, Quinolones, Randomized Controlled Trials as Topic, Scopolamine Derivatives, Severity of Illness Index, Treatment Outcome, Science & Technology, Life Sciences & Biomedicine, Respiratory System, RESPIRATORY SYSTEM, COPD, Bronchodilator, Systematic review, Meta-analysis, Mixed treatment comparison, OBSTRUCTIVE PULMONARY-DISEASE, ONCE-DAILY INDACATEROL, MIXED TREATMENT COMPARISONS, 75 MU-G, RANDOMIZED CONTROLLED-TRIALS, FIXED-DOSE COMBINATIONS, TWICE-DAILY SALMETEROL, FORMOTEROL DRY POWDER, ISPOR TASK-FORCE, FLUTICASONE PROPIONATE, Respiratory System, 1102 Cardiovascular Medicine And Haematology, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: RESPIRATORY RESEARCH
ISSN: 1465-993X
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Dates:
DateEvent
7 October 2013Published
Web of Science ID: WOS:000327744400001
URI: https://openaccess.sgul.ac.uk/id/eprint/107095
Publisher's version: https://doi.org/10.1186/1465-9921-14-100

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