Source: Annual Congress 2012 - COPD treatments: efficacy and safety
Disease area: Airway diseases

Abstract

Introduction. Dyspnoea is a common, troublesome symptom of COPD. It is useful to know how patients (pts) with varying degrees of breathlessness respond to treatment.
Aim. We explored the effectiveness of the once-daily(od) long-acting inhaled bronchodilators indacaterol(IND) and tiotropium(TIO) in COPD pts according to baseline dyspnoea severity(median modified Medical Research Council[mMRC] score <2.0 or ≥2.0[ie less or more dyspnoea]).
Methods. Data were pooled from three randomized studies of double-blind IND 150µg od(n=745), IND 300µg od(n=849) and placebo(PBO; n=1171) and open-label(o/l) TIO 18µg od(n=411) in pts with moderate-to-severe COPD. Trough FEV₁, transition dyspnoea index(TDI), St George‘s Respiratory Questionnaire(SGRQ) and odds ratios(OR) for clinically relevant response in TDI(≥1 point) and SGRQ(≥ -4 units) were evaluated at 6 months.
Results. In pts with mMRC <2/≥2 respectively(n=1425/1752), mean age was 63.1/63.9 years, FEV₁ 57.6/51.8% predicted, FEV₁/FVC 53.9/51.6%. Differences vs PBO for outcomes in each subgroup are shown in table(p<0.05 vs *PBO, ^†TIO or ^‡IND 150).

		mMRC <2			mMRC ≥2
	IND150	IND300	TIO	IND150	IND300	TIO
n	341	373	173	404	476	238
Trough FEV1, mL	180*	180*	150*	140*	170*†	130*
TDI total score	1.21*	1.33*	1.26*	0.83*	1.24*†	0.63*
TDI responder OR	2.09*	2.44*	1.79*	1.77*	2.91*†‡	1.34
SGRQ total score	-4.7*	-3.9*	-2.3	-4.0*†	-3.0*	-1.6
SGRQ responder OR	2.03*	1.56*	1.40	1.90*†	1.74*	1.29

Conclusions. In pts with less severe dyspnoea(mMRC <2), IND 150, IND 300 and o/l TIO were similarly effective. In pts with more severe dyspnoea(mMRC ≥2), IND 300 was more effective than IND 150 and o/l TIO in improving dyspnoea. Increasing the IND dose to 300µg may be useful for pts with more severe dyspnoea.

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Citations should be made in the following way:
D. Mahler, R. Buhl, D. Lawrence, D. McBryan (Lebanon, United States Of America; Mainz, Germany; Horsham, United Kingdom; Basel, Switzerland). Effectiveness of indacaterol and tiotropium in patients with severe dyspnoea. Eur Respir J 2012; 40: Suppl. 56, 2101

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