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Comparison of clinical efficacy and safety between indacaterol and tiotropium in COPD: meta-analysis of randomized controlled trials

 Jung Soo Kim  ;  Jinkyeong Park  ;  Seong Yong Lim  ;  Yeon-Mok Oh  ;  Kwang Ha Yoo  ;  Yong Bum Park  ;  Seung Soo Sheen  ;  Min-Ji Kim  ;  K. C. Carriere  ;  Ji Ye Jung  ;  Hye Yun Park 
 PLOS ONE, Vol.10(3) : e0119948, 2015 
Journal Title
Issue Date
Adrenergic beta-2 Receptor Agonists/therapeutic use ; Bronchodilator Agents/therapeutic use ; Forced Expiratory Volume/drug effects ; Humans ; Indans/therapeutic use* ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Quinolones/therapeutic use* ; Randomized Controlled Trials as Topic ; Tiotropium Bromide/therapeutic use* ; Treatment Outcome
Two once-daily inhaled bronchodilators, indacaterol and tiotropium, are widely used as first-line therapy in stable COPD patients. This study was performed to compare the clinical efficacy and safety between indacaterol and tiotropium in patients with moderate-to-severe COPD. MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched to identify all published randomized controlled trials (RCTs). The primary outcome was trough forced expiratory volume in 1 second (FEV1) at week 12. Four RCTs were eligible for inclusion (three RCTs with moderate-to-severe COPD patients and one RCT with only severe COPD patients). Trough FEV₁ at weeks 12 and 26 were not significantly different between indacaterol and tiotropium by the standardized mean difference with 0.014 (95% CI, -0.036, 0.063, I²= 23.5%) and with 0.037 (95% CI, -0.059 to 0.133, I²= 0%) along with differences in means of 0.003L and 0.014L, respectively. Indacaterol and tiotropium also showed similar St. George's Respiratory Questionnaire (SGRQ) total scores and percentages of patients with SGRQ improvement (≥ 4 units) at week 26. The incidences of nasopharyngitis, serious cardiovascular events, and serious adverse events were not different between indacaterol and tiotropium, while those of cough (OR = 1.68, P < 0.001, and RR = 1.63) and COPD worsening (OR = 1.18, P = 0.003, and RR = 1.12) were higher for indacaterol than tiotropium. However, when one study with only severe COPD patients was removed from the meta-analysis, the difference in the incidence of COPD worsening between indacaterol and tiotropium became non-significant (OR = 1.13, P = 0.204, and RR = 1.09). The clinical efficacy and serious adverse events between indacaterol and tiotropium were equivocal in patients with moderate-to-severe COPD. Cough is a common complaint associated with indacaterol, and COPD worsening needs to be carefully monitored in severe COPD patients when treated with indacaterol.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Jung, Ji Ye(정지예) ORCID logo https://orcid.org/0000-0003-1589-4142
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