Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 10 » Issue 1

Comparative efficacy of combination bronchodilator therapies in COPD: a network meta-analysis

Authors Huisman E, Cockle S, Ismaila AS, Karabis A, Punekar Y

Received 21 April 2015

Accepted for publication 17 July 2015

Published 9 September 2015 Volume 2015:10(1) Pages 1863—1881


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Dr Richard Russell

Eline L Huisman,1 Sarah M Cockle,2 Afisi S Ismaila,3,4 Andreas Karabis,1 Yogesh Suresh Punekar2

1Mapi Group, Real World Strategy and Analytics and Strategic Market Access, Houten, the Netherlands; 2Value Evidence and Outcomes, GlaxoSmithKline, Uxbridge, UK; 3Value Evidence and Outcomes, GlaxoSmithKline R&D, Research Triangle Park, NC, USA; 4Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

Background: Several new fixed-dose combination bronchodilators have been recently launched, and assessing their efficacy relative to each other, and with open dual combinations is desirable. This network meta-analysis (NMA) assessed the efficacy of umeclidinium and vilanterol (UMEC/VI) with that of available dual bronchodilators in single/separate inhalers.
Methods: A systematic literature review identified randomized controlled trials of ≥10 weeks among chronic obstructive pulmonary disease patients (≥40 years), assessing the efficacy of combination bronchodilators in single or separate inhalers. Comparative assessment was conducted on change from baseline in trough forced expiratory volume in 1 second (FEV1), St George’s Respiratory Questionnaire (SGRQ) total scores, transitional dyspnea index (TDI) focal scores, and rescue medication use at 12 weeks and 24 weeks using an NMA within a Bayesian framework.
Results: A systematic literature review identified 77 articles of 26 trials comparing UMEC/VI, indacaterol/glycopyrronium (QVA149), formoterol plus tiotropium (TIO) 18 µg, salmeterol plus TIO, or indacaterol plus TIO, with TIO and placebo as common comparators at 12 weeks and approximately 24 weeks. The NMA showed that at 24 weeks, efficacy of UMEC/VI was not significantly different compared with QVA149 on trough FEV1 (14.1 mL [95% credible interval: -14.2, 42.3]), SGRQ total score (0.18 [-1.28, 1.63]), TDI focal score (-0.30 [-0.73, 0.13]), and rescue medication use (0.02 [-0.27, 0.32]); compared with salmeterol plus TIO on trough FEV1 (67.4 mL [-25.3, 159.4]), SGRQ total score (-0.11 [-1.84, 1.61]), and TDI focal score (0.58 [-0.33, 1.50]); and compared with formoterol plus TIO 18 µg on SGRQ total score (-0.68 [-1.77, 0.39]). Results at week 12 were consistent with week 24 outcomes. Due to lack of availability of evidence, no comparison was made with formoterol plus TIO on FEV1 or TDI at 24 weeks.
Conclusion: UMEC/VI has comparable efficacy to other dual-bronchodilator combinations on available efficacy endpoints.

Keywords: LABA/LAMA, UMEC/VI, QVA149, fomoterol, tiotropium, glycopyrronium, indacaterol, umeclidinium

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at 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]


Readers of this article also read:

A real-world evaluation of indacaterol and other bronchodilators in COPD: the INFLOW study

Juvelekian G, El-Sorougi W, Pothirat C, Yunus F, De Guia T, Kuo H, Basu Patnaik S, Pilipovic V

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:2109-2120

Published Date: 5 October 2015

Assessments of endothelial function and arterial stiffness are reproducible in patients with COPD

Rodriguez-Miguelez P, Seigler N, Bass L, Dillard TA, Harris RA

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1977-1986

Published Date: 16 September 2015

Physical inactivity and arterial stiffness in COPD

Sievi NA, Franzen D, Kohler M, Clarenbach CF

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1891-1897

Published Date: 10 September 2015

Ultraviolet light and laser irradiation enhances the antibacterial activity of glucosamine-functionalized gold nanoparticles

Govindaraju S, Ramasamy M, Baskaran R, Ahn SJ, Yun KS

International Journal of Nanomedicine 2015, 10:67-78

Published Date: 25 August 2015

Positioning new pharmacotherapies for COPD

Barjaktarevic IZ, Arredondo AF, Cooper CB

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1427-1442

Published Date: 24 July 2015

LANTERN: a randomized study of QVA149 versus salmeterol/fluticasone combination in patients with COPD

Zhong N, Wang C, Zhou X, Zhang N, Humphries M, Wang L, Thach C, Patalano F, Banerji D

International Journal of Chronic Obstructive Pulmonary Disease 2015, 10:1015-1026

Published Date: 5 June 2015