Efficacy And Safety Of Three Dosages Of Indacaterol For Moderate To Severe COPD:A Network Meta-analysis

Background and Objective:Indacaterol is an inhaled long-acting?₂-agonist that improves breathless,health status and exacerbation rate.Currently,there are three doses?75,150,and 300?g?of indacaterol,but it is still not clear which is more advantageous.This study is to assess the efficacy and safety of three dosages?75,150,and 300?g?of indacaterol in patients with moderate-to-severe COPD by network meta-analysis.Methods:We electronically searched databases including PubMed,EMbase,The Cochrane Library,CBM,CNKI,WanFang Data and VIP Databases to collect randomized controlled trials?RCTs?related to indacaterol for treating stable COPD patients from inception to December 31^st,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 software were used to perform network meta-analysis.Results:A total of 14 RCTs involving 6141 patients were included.The results of network Meta-analysis showed that:Compared to placebo,three dosages of indacaterol can improve trough forced expiratory volume in 1 second?Trough FEV₁?,but no statistically differences were found between three dosages of indacaterol.The effect of indacaterol 150?g and 300?g were better than that of placebo in reducing COPD exacerbation rate,but no statistically significant differences were found between indacaterol 75?g and placebo or three dosages of indacaterol.Compared to placebo,three dosages of indacaterol can improve St George respiratory questionnaire?SGRQ?,but no statistically differences were found between three dosages of indacaterol.Only indacaterol 300?g improved SGRQ by more than 4 points,exceeding the minimal clinical important difference?MCID?.Compared to placebo,three dosages of indacaterol can improve transitional dyspnea index?TDI?,but no statistically differences were found between three dosages of indacaterol.Only indacaterol 300?g improved TDI by more than 1 points,exceeding the MCID.There were no statistically differences between indacaterol and placebo or there dosages of indacaterol in incidence of all adverse effects.Ranking probability table showed that indacaterol 300?g is most likely to be the most effective treatment in improving Trough FEV₁,SGRQ and TDI,and it was second only to indacaterol 150?g in reducing COPD exacerbation rate.Conclusion:Indacaterol 300?g is superior to the other two dosages in improving trough FEV₁,SGRQ and TDI in patients with stable moderate-to-severe COPD,and it was second only to indacaterol 150?g in reducing COPD exacerbation rate.All have good safety profile.