Efficacy and Safety of a Fixed-Dose Combination of Indacaterol and Glycopyrronium for the Treatment of COPD A Systematic Review
Por:
Rodrigo, GJ, Plaza, V
Publicada:
1 ago 2014
Resumen:
BACKGROUND: COPD guidelines recommend the combined use of inhaled, long-acting beta 2-agonists and long-acting muscarinic antagonists if symptoms are not improved by a single agent. This systematic review assessed the efficacy and safety of the fixed-dose combination of the long-acting beta 2-agonist indacaterol and long-acting muscarinic antagonist glycopyrronium (QVA149) compared with its monocomponents (glycopyrronium and indacaterol) and tiotropium for the treatment of moderate to severe COPD.
METHODS: This was a systematic review of randomized, placebo-controlled or crossover trials (3-64 weeks). Primary outcomes were trough FEV 1, severe adverse events, and serious cardiovascular events.
RESULTS: Five trials (4,842 patients) were included. Compared with tiotropium, QVA149 showed a significant increase in trough FEV 1 (70 mL; P<.0001) and a decreased use of rescue medication (2 0.63 puff s/d; P<.0001). Patients receiving QVA149 had a 19% greater likelihood of experiencing a minimal clinical important difference (MCID) in the number needed to treat for benefit (NNTB) (NNTB 5 11) and a 16% greater likelihood of achieving an MCID in the St. George's Respiratory Questionnaire (SGRQ) (NNTB 5 11). Similarly, QVA149 vs glycopyrronium showed a significant increase in trough FEV 1 (70 mL; P<.0001), a signifi cant reduction in rescue medication use (2 0.59; P<.0001), and a signifi cant increase in the rate of patients achieving an MCID in the SGRQ (NNTB 5 12). QVA149 showed similar levels of safety and tolerability to both comparators. It was not possible to perform a pooled analysis of data comparing QVA149 vs indacaterol.
CONCLUSIONS: Once-daily, inhaled QVA149 showed superior efficacy compared with glycopyrronium and the current standard of care, tiotropium, in patients with moderate to severe COPD.
Filiaciones:
Rodrigo, GJ:
Hosp Cent Fuerzas Armadas, Dept Emergencia, Montevideo 11300, Uruguay
Plaza, V:
Univ Autonoma Barcelona, Serv Pneumol, Hosp Santa Creu & Sant Pau, E-08193 Barcelona, Spain
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