Comparative efficacy of long-acting β2-agonists as monotherapy for chronic obstructive pulmonary disease: A network meta-analysis

James F. Donohue, Keith A. Betts, Ella Xiaoyan Du, Pablo Altman, Pankaj Goyal, Dorothy L. Keininger, Jean Bernard Gruenberger, James E. Signorovitch

Research output: Contribution to journalArticle

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Abstract

Purpose: 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 FEV1 compared 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 FEV1 compared 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. Conclusion: Indacaterol 300 μg, followed by 150 and 75 μg, were the most effective LABA monotherapies for moderate to severe COPD.

LanguageEnglish (US)
Pages367-381
Number of pages15
JournalInternational Journal of COPD
Volume12
DOIs
StatePublished - Jan 19 2017

Fingerprint

Chronic Obstructive Pulmonary Disease
Dyspnea
Forced Expiratory Volume
Network Meta-Analysis
indacaterol
Randomized Controlled Trials
olodaterol
Clinical Trials
Formoterol Fumarate
Salmeterol Xinafoate
vilanterol

Keywords

  • COPD
  • Indacaterol
  • Long-acting β2-agonists
  • Network meta-analysis
  • Systematic literature review

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Comparative efficacy of long-acting β2-agonists as monotherapy for chronic obstructive pulmonary disease : A network meta-analysis. / Donohue, James F.; Betts, Keith A.; Du, Ella Xiaoyan; Altman, Pablo; Goyal, Pankaj; Keininger, Dorothy L.; Gruenberger, Jean Bernard; Signorovitch, James E.

In: International Journal of COPD, Vol. 12, 19.01.2017, p. 367-381.

Research output: Contribution to journalArticle

Donohue, JF, Betts, KA, Du, EX, Altman, P, Goyal, P, Keininger, DL, Gruenberger, JB & Signorovitch, JE 2017, 'Comparative efficacy of long-acting β2-agonists as monotherapy for chronic obstructive pulmonary disease: A network meta-analysis' International Journal of COPD, vol. 12, pp. 367-381. DOI: 10.2147/COPD.S119908
Donohue, James F. ; Betts, Keith A. ; Du, Ella Xiaoyan ; Altman, Pablo ; Goyal, Pankaj ; Keininger, Dorothy L. ; Gruenberger, Jean Bernard ; Signorovitch, James E./ Comparative efficacy of long-acting β2-agonists as monotherapy for chronic obstructive pulmonary disease : A network meta-analysis. In: International Journal of COPD. 2017 ; Vol. 12. pp. 367-381
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abstract = "Purpose: 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 FEV1 compared 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 FEV1 compared 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. Conclusion: Indacaterol 300 μg, followed by 150 and 75 μg, were the most effective LABA monotherapies for moderate to severe COPD.",
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