Indacaterol compared with tiotropium in the treatment of chronic obstructive pulmonary disease: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

JIANG Xunsheng , ZHANG Yanxia , DONG Biwen , ZHOU Na ,  JIAO Shenshan

Department of Respiratory Medicine, Nanchang Third Hospital, Nanchang, 330006, P.R.China;

Corresponding author：

JIAO Shenshan, Email: 15879110756@163.com

Keywords：

Indacaterol; Tiotropium; Chronic obstructive pulmonary disease; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201612051

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ObjectiveTo systematically review the efficacy and safety of indacaterol compared with tiotropium in the treatment of chronic obstructive pulmonary disease (COPD).MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) about indacaterol versus tiotropium for COPD patients from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.1 software.ResultsA total of 10 RCTs involving 10 415 patients were included, 5 686 patients were in tiotropium group and 4 729 patients in tiotropium group. The results of meta-analysis showed that there was no significant difference between both groups for improving trough forced expiratory volume in one second pulmonary function (FEV₁) (MD=0.00, 95%CI –0.03 to 0.03, P=0.79). In the subgroup analysis, it was found that indacaterol had a significant advantage over tiotropium in improving FEV₁ over the first 2 weeks (MD=–0.05, 95%CI –0.10 to 0.00, P=0.03). As to the transition dyspnoea index, indoruterol was superior to tiotropium (RR=1.09, 95%CI 1.05 to 1.14, P<0.000 1). Although there was no significant difference of two groups in the St George's respiratory questionnaire score (SGRQ) (MD=–0.48, 95%CI –1.42 to 0.47, P=0.32), indoruterol could significantly improve it among patients whose SGRQ score was greater than or equal 4 than tiotropium (RR=1.13, 95%CI 1.05 to 1.22, P=0.002). Indoruterol had lower overall incidence of adverse reactions (RR=1.05, 95%CI 1.01 to 1.09, P=0.01) , but there was no significant difference between two groups in severe adverse events (RR=1.02, 95%CI 0.89 to 1.16, P=0.81).ConclusionIndacaterol and tiotropium are similar in improving lung function in COPD patients, however, the indacaterol is better than tiotropium in TDI and SGRQ. There is no significant difference for the serious adverse reactions in two groups. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： JIANG Xunsheng, ZHANG Yanxia, DONG Biwen, ZHOU Na, JIAO Shenshan. Indacaterol compared with tiotropium in the treatment of chronic obstructive pulmonary disease: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(7): 783-791. doi: 10.7507/1672-2531.201612051 Copy

1.	慢性阻塞性肺疾病诊治指南(2013 年修订版). 中国医学前沿杂志(电子版), 2014, 6(2): 67-80.
2.	中华人民共和国卫生部医政司. 慢性阻塞性肺疾病诊疗规范(2011 版), 卫办医政发[2011]108号. Available at: http://www. moh.gov.cn.
3.	Abdool-Gaff MS, Ambaram A, Ainslie GM, et al. Guideline for the management of chronic obstructive pulmonary disease-2011 update. SAMJ, 2011, 101(1): 62-73.
4.	Lopez AD, Shibuya K, Rao C, et al. Chronic obstructive pulmonary disease: current burden and fiiture projections. Eur Respir J, 2006, 27(2): 397-412.
5.	Chung VC, Ma PH, Hui DS, et al. Indacaterol for chronic obstructive pulmonary disease: systematic review and meta-analysis. PLoS One, 2013, 8(8): e70784.
6.	Han J, Dai L, Zhong N, et al. Indacaterol on dyspnea in chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized placebo-controlled trials. BMC Pulm Med, 2013, 13(1): 26.
7.	Yohannes AM, Willgoss TG, Vestbo J. Tiotropium for treatment of stable COPD: a meta-analysis of clinically relevant outcomes. Respir Care, 2011, 56(4): 477-487.
8.	Karner C, Chong J, Poole P. Tiotropium versus placebo for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2012, (7): CD0009285.
9.	蔡柏蔷. 茚达特罗-GOLD 推荐的慢阻肺稳定期治疗用长效支气管扩张剂. 中国实用内科杂志, 2013, 33(S1): 21-22.
10.	刘鸣. 系统评价 Meta 分析设计与实施方法. 北京: 人民卫生出版社, 2011: 70-71.
11.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at: http://www. cochrane-handbook.org.
12.	Barnes PJ, Pocock SJ, Magnussen H, et al. Integrating indacaterol dose selection in a clinical study in COPD using an adaptive seamless design. Pulm Phar Ther, 2010, 23(3): 165-171.
13.	Bateman ED, Ferguson GT, Barnes N, et al. Dual bronchodilation with QVA149 versus single bronchodilator therapy: the SHINE study. Eur Respir J, 2013, 42(6): 1484-1494.
14.	Buhl R, Dunn LJ, Disdier C, et al. Blinded 12-week comparison of once-daily indacaterol and tiotropium in COPD. Eur Respir J, 2011, 38(4): 797-803.
15.	Decramer M, Rossi A, Lawrence D, et al. Indacaterol therapy in patients with COPD not receiving other maintenance treatment. Res Med, 2012, 106(12): 1706-1714.
16.	Decramer ML, Chapman KR, Dahl R, et al. Once-daily indacaterol versus tiotropium for patients with severe chronic obstructive pulmonary disease (INVIGORATE): a randomised, blinded, parallel-group study. Lancet Res Med, 2013, 1(7): 524-533.
17.	Donohue JF, Fogarty C, Lötvall J, et al. Once-daily bronchodilators for chronic obstructive pulmonary disease: indacaterol versus tiotropium. Am J Respir Crit Care Med, 2010, 182(2): 155-162.
18.	Hashimoto I, Shu H, Shujiro M, et al. Efficacy and safety of indacaterol/glycopyrronium in Japanese patients with COPD: a subgroup analysis from the SHINE study. Int J COPD, 2016, 11(1): 2543-2551.
19.	Hoshino M, Ohtawa J. Computed tomography assessment of airway dimensions with combined tiotropium and indacaterol therapy in COPD patients. Respirology, 2014, 19(3): 403-410.
20.	Juvelekian G, El-Sorougi W, Pothirat C, et al. A real-world evaluation of indacaterol and other bronchodilators in COPD: the INFLOW study. Int J Chron Obstruct Pulmon Dis, 2015(1), 10: 2109-2120.
21.	Mahler DA, Kerstjens HAM, Donohue JF, et al. Indacaterol vs tiotropium in COPD patients classified as GOLD A and B. Res Med, 2015, 1(8): 1031-1039.
22.	Kew KM, Dias S, Cates CJ. Long-acting inhaled therapy (beta agonists, anticholinergics and steroids) for COPD: a network meta analysis. Cochrane Database Syst Rev, 2014, (3): CD010844.
23.	Puhan MA, Bachmann LM, Kleijnen J, et al. Inhaled drugs to reduce exacerbations in patients with chronic obstructive pulmonary disease: a network meta-analysis. BMC Med, 2009, 7(1): 1-14.
24.	van der Meer RM, Wagena EJ, Ostelo RW, et al. Smoking cessation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2003, (2): CD002999.
25.	许成芳, 朱建波, 梁芳. 沙美特罗/氟替卡松(50/500)吸入治疗缓解期慢性阻塞性肺疾病 72 例. 实用医学杂志, 2009, 25(23): 4054-4056.
26.	Karner C, Cates CJ. The effect of adding inhaled corticosteroids to tiotropium and long-acting beta2-agonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2011, (9): CD009039.
27.	Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Am J Respir Crit Care Med, 2017, 195(5): 557-582.
28.	Welte T, Miravitlles M, Hernandez P, et al. Efficacy and tolerability of budesonide/formoterol added to tiotropium in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2009, 180(8): 741-750.
29.	曾林淼, 俞晓莲, 张清华, 等. 布地奈德/福莫特罗联合噻托溴铵治疗中国慢性阻塞性肺疾病患者有效性和安全性的 Meta 分析. 中国循证医学杂志, 2016, 16(3): 325-333.
30.	Lombardi D, Cuenoud B, Krämer SD. Lipid membrane interactions of indacaterol and salmeterol: do they influence their pharmacological properties. Eur J Pharm Sci, 2009, 38(5): 533-547.
31.	Rodrigo GJ, Neffen H. Comparison of indacaterol with tiotropium or twice-daily long-acting β-agonists for stable COPD: a systematic review. Chest, 2012, 142(5): 1104-1110.
32.	蔡倩, 徐峥, 刘蕾. 马来酸茚达特罗治疗慢性阻塞性肺疾病的 Meta 分析. 中国药学杂志, 2015, 50(5): 449-453.

1. 慢性阻塞性肺疾病诊治指南(2013 年修订版). 中国医学前沿杂志(电子版), 2014, 6(2): 67-80.
2. 中华人民共和国卫生部医政司. 慢性阻塞性肺疾病诊疗规范(2011 版), 卫办医政发[2011]108号. Available at: http://www. moh.gov.cn.
3. Abdool-Gaff MS, Ambaram A, Ainslie GM, et al. Guideline for the management of chronic obstructive pulmonary disease-2011 update. SAMJ, 2011, 101(1): 62-73.
4. Lopez AD, Shibuya K, Rao C, et al. Chronic obstructive pulmonary disease: current burden and fiiture projections. Eur Respir J, 2006, 27(2): 397-412.
5. Chung VC, Ma PH, Hui DS, et al. Indacaterol for chronic obstructive pulmonary disease: systematic review and meta-analysis. PLoS One, 2013, 8(8): e70784.
6. Han J, Dai L, Zhong N, et al. Indacaterol on dyspnea in chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized placebo-controlled trials. BMC Pulm Med, 2013, 13(1): 26.
7. Yohannes AM, Willgoss TG, Vestbo J. Tiotropium for treatment of stable COPD: a meta-analysis of clinically relevant outcomes. Respir Care, 2011, 56(4): 477-487.
8. Karner C, Chong J, Poole P. Tiotropium versus placebo for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2012, (7): CD0009285.
9. 蔡柏蔷. 茚达特罗-GOLD 推荐的慢阻肺稳定期治疗用长效支气管扩张剂. 中国实用内科杂志, 2013, 33(S1): 21-22.
10. 刘鸣. 系统评价 Meta 分析设计与实施方法. 北京: 人民卫生出版社, 2011: 70-71.
11. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at: http://www. cochrane-handbook.org.
12. Barnes PJ, Pocock SJ, Magnussen H, et al. Integrating indacaterol dose selection in a clinical study in COPD using an adaptive seamless design. Pulm Phar Ther, 2010, 23(3): 165-171.
13. Bateman ED, Ferguson GT, Barnes N, et al. Dual bronchodilation with QVA149 versus single bronchodilator therapy: the SHINE study. Eur Respir J, 2013, 42(6): 1484-1494.
14. Buhl R, Dunn LJ, Disdier C, et al. Blinded 12-week comparison of once-daily indacaterol and tiotropium in COPD. Eur Respir J, 2011, 38(4): 797-803.
15. Decramer M, Rossi A, Lawrence D, et al. Indacaterol therapy in patients with COPD not receiving other maintenance treatment. Res Med, 2012, 106(12): 1706-1714.
16. Decramer ML, Chapman KR, Dahl R, et al. Once-daily indacaterol versus tiotropium for patients with severe chronic obstructive pulmonary disease (INVIGORATE): a randomised, blinded, parallel-group study. Lancet Res Med, 2013, 1(7): 524-533.
17. Donohue JF, Fogarty C, Lötvall J, et al. Once-daily bronchodilators for chronic obstructive pulmonary disease: indacaterol versus tiotropium. Am J Respir Crit Care Med, 2010, 182(2): 155-162.
18. Hashimoto I, Shu H, Shujiro M, et al. Efficacy and safety of indacaterol/glycopyrronium in Japanese patients with COPD: a subgroup analysis from the SHINE study. Int J COPD, 2016, 11(1): 2543-2551.
19. Hoshino M, Ohtawa J. Computed tomography assessment of airway dimensions with combined tiotropium and indacaterol therapy in COPD patients. Respirology, 2014, 19(3): 403-410.
20. Juvelekian G, El-Sorougi W, Pothirat C, et al. A real-world evaluation of indacaterol and other bronchodilators in COPD: the INFLOW study. Int J Chron Obstruct Pulmon Dis, 2015(1), 10: 2109-2120.
21. Mahler DA, Kerstjens HAM, Donohue JF, et al. Indacaterol vs tiotropium in COPD patients classified as GOLD A and B. Res Med, 2015, 1(8): 1031-1039.
22. Kew KM, Dias S, Cates CJ. Long-acting inhaled therapy (beta agonists, anticholinergics and steroids) for COPD: a network meta analysis. Cochrane Database Syst Rev, 2014, (3): CD010844.
23. Puhan MA, Bachmann LM, Kleijnen J, et al. Inhaled drugs to reduce exacerbations in patients with chronic obstructive pulmonary disease: a network meta-analysis. BMC Med, 2009, 7(1): 1-14.
24. van der Meer RM, Wagena EJ, Ostelo RW, et al. Smoking cessation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2003, (2): CD002999.
25. 许成芳, 朱建波, 梁芳. 沙美特罗/氟替卡松(50/500)吸入治疗缓解期慢性阻塞性肺疾病 72 例. 实用医学杂志, 2009, 25(23): 4054-4056.
26. Karner C, Cates CJ. The effect of adding inhaled corticosteroids to tiotropium and long-acting beta2-agonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2011, (9): CD009039.
27. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Am J Respir Crit Care Med, 2017, 195(5): 557-582.
28. Welte T, Miravitlles M, Hernandez P, et al. Efficacy and tolerability of budesonide/formoterol added to tiotropium in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2009, 180(8): 741-750.
29. 曾林淼, 俞晓莲, 张清华, 等. 布地奈德/福莫特罗联合噻托溴铵治疗中国慢性阻塞性肺疾病患者有效性和安全性的 Meta 分析. 中国循证医学杂志, 2016, 16(3): 325-333.
30. Lombardi D, Cuenoud B, Krämer SD. Lipid membrane interactions of indacaterol and salmeterol: do they influence their pharmacological properties. Eur J Pharm Sci, 2009, 38(5): 533-547.
31. Rodrigo GJ, Neffen H. Comparison of indacaterol with tiotropium or twice-daily long-acting β-agonists for stable COPD: a systematic review. Chest, 2012, 142(5): 1104-1110.
32. 蔡倩, 徐峥, 刘蕾. 马来酸茚达特罗治疗慢性阻塞性肺疾病的 Meta 分析. 中国药学杂志, 2015, 50(5): 449-453.

Chinese Journal of Evidence-Based Medicine

Indacaterol compared with tiotropium in the treatment of chronic obstructive pulmonary disease: a meta-analysis

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