Comparative efficacy of aclidinium versus glycopyrronium and tiotropium, as maintenance treatment of moderate to severe COPD patients: a systematic review and network meta-analysis
Authors Karabis A, Lindner L, Mocarski M, Huisman E, Greening A
Received 24 May 2013
Accepted for publication 10 July 2013
Published 9 September 2013 Volume 2013:8 Pages 405—423
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Andreas Karabis,1 Leandro Lindner,2 Michelle Mocarski,3 Eline Huisman,1 Andrew Greening4
1MAPI Consultancy, AX Houten, The Netherlands; 2Almirall SA, Barcelona, Spain; 3Health Economics and Outcomes Research, Forest Research Institute, Jersey City, NJ, USA; 4University of Edinburgh, Lothian University Hospitals' Division, Edinburgh, UK
Background: Aclidinium bromide is a new long-acting muscarinic antagonist (LAMA) indicated for maintenance bronchodilator treatment of chronic obstructive pulmonary disease (COPD). The efficacy of aclidinium was compared with tiotropium and glycopyrronium, using a network meta-analysis (NMA) of randomized controlled trials (RCTs) in moderate-to-severe COPD patients.
Methods: A systematic review was performed to identify RCTs evaluating aclidinium 400 µg twice daily (BID), glycopyrronium 50 µg once daily (OD), tiotropium 18 µg OD, or tiotropium 5 µg OD in adults with moderate-to-severe COPD. The outcomes of interest were: trough forced expiratory volume in 1 second (FEV1); St George's Respiratory Questionnaire (SGRQ) total score and proportion of patients achieving ≥4 unit change; Transition Dyspnea Index (TDI) focal score and proportion of patients achieving ≥1 point change. The results were synthesized by means of a Bayesian NMA.
Results: Twenty-one studies (22,542 patients) were included: aclidinium 400 µg BID (three studies); tiotropium 5 µg OD (three studies); tiotropium 18 µg OD (13 studies); and glycopyrronium 50 µg OD (two studies). Regarding trough FEV1 at 24 weeks, aclidinium demonstrated comparable efficacy to tiotropium 5 µg (difference in change from baseline [CFB]), (0.02 L [95% credible interval CrI −0.05, 0.09]); tiotropium 18 µg (0.02 L [95% CrI −0.05, 0.08]); and glycopyrronium (0.00 L [95% CrI −0.07, 0.07]). Aclidinium resulted in higher improvement in SGRQ score at 24 weeks, compared to tiotropium 5 µg (difference in CFB, −2.44 [95% CrI −4.82, −0.05]); and comparable results to tiotropium 18 µg (−1.80 [95% CrI −4.52, 0.14]) and glycopyrronium (−1.52 [95% CrI −4.08, 1.03]). Improvements in TDI score were comparable for all treatments.
Conclusion: Maintenance treatment with aclidinium 400 µg BID is expected to produce similar improvements in lung function, health-related quality of life, and dyspnea compared to tiotropium 5 µg OD; tiotropium 18 µg OD; and glycopyrronium 50 µg OD.
Keywords: COPD, aclidinium, tiotropium, glycopyrronium, systematic review, network meta-analysis
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]