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.
ObjectivesTo assess the efficacy and safety of 3 dosages (75, 150, and 300 μg) of indacaterol in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) by network meta-analysis.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of indacaterol for treating stable COPD patients from inception to December 31st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then ADDIS 1.16.8 and Stata 15.1 softwares were used to perform network meta-analysis.ResultsA total of 13 RCTs involving 5 476 patients were included. The results of network meta-analysis showed that: compared to placebo, 3 dosages of indacaterol could improve trough forced expiratory volume in 1 second (trough FEV1), lower St George respiratory questionnaire (SGRQ), and improve transitional dyspnea index (TDI). 150 μg and 300 μg groups were better than placebo group in reducing COPD exacerbation rate. There were no statistically differences between groups in incidence of all adverse effects. Ranking probability table showed that 300 μg group was most likely to be the most effective treatment in improving trough FEV1, SGRQ and TDI, and it ranked second in reducing COPD exacerbation rate.ConclusionsConsidering the network meta-analysis and rankings, 300 μg indacaterol is superior to the other 2 dosages in treating the patients with moderate-to-severe COPD.