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

Purpose: Long-acting beta 2-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 mu g twice daily [BID]; formoterol 12 mu g BID; indacaterol 75, 150, and 300 mu g once daily [OD]; olodaterol 5 and 10 mu g OD, and vilanterol 25 mu g 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 mu g OD were associated with statistically significant improvement in trough FEV1 compared to all other LABA monotherapies; vilanterol 25 mu g OD was superior to formoterol 12 mu g BID. At 12 weeks, indacaterol 75 mu g OD was associated with significant improvement in trough FEV1 compared to formoterol 12 mu g BID and olodaterol (5 and 10 mu g OD); salmeterol 50 mu g BID was superior to formoterol 12 mu g BID and olodaterol 5 mu g OD. Indacaterol 300 mu g 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 mu g OD had significantly better results in exacerbation rates than olodaterol 5 mu g and olodaterol 10 mu g OD. Conclusion: Indacaterol 300 mu g, followed by 150 and 75 mu g, were the most effective LABA monotherapies for moderate to severe COPD.