Comparison of indacaterol with tiotropium or twice-daily long-acting β -agonists for stable COPD: a systematic review

Chest. 2012 Nov;142(5):1104-1110. doi: 10.1378/chest.11-2252.


Background: Bronchodilators are central to the symptomatic management of patients with COPD.Previous data have shown that inhaled indacaterol improved numerous clinical outcomes over placebo.

Methods: This systematic review explored the efficacy and safety of indacaterol in comparison with tiotropium or bid long-acting β 2 -agonists (TD-LABAs) for treatment of moderate to severe COPD. Randomized controlled trials were identified after a search of different databases of published and unpublished trials.

Results: Five trials (5,920 participants) were included. Compared with tiotropium, indacaterol showed statistically and clinically significant reductions in the use of rescue medication and dyspnea(43% greater likelihood of achieving a minimal clinically important difference [MCID] in the transitional dyspnea index [TDI]; number needed to treat for benefit [NNTB] 5 10). Additionally,the MCID in health status was more likely to be achieved with indacaterol than with tiotropium (OR = 1.43; 95% CI, 1.22–1.68; P = .00001; [NNTB ]= 10). Trough FEV 1 was significantly higher at the end of treatment with indacaterol than with TD-LABAs (80 mL, P = .00001). Similarly, indacaterol signifi cantly improved dyspnea (61% greater likelihood of achieving an MCID in TDI, P = .008) and health status (21% greater likelihood of achieving an MCID in St. George’s Respiratory Questionnaire, P 5 .04) than TD-LABA. Indacaterol showed similar levels of safety and tolerability to both comparators.

Conclusions: Available evidence suggests that indacaterol may prove useful as an alternative to tiotropium or TD-LABA due to its effects on health status, dyspnea, and pulmonary function.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adrenergic beta-Agonists / administration & dosage*
  • Bronchodilator Agents / administration & dosage*
  • Evidence-Based Medicine
  • Humans
  • Indans / administration & dosage*
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Quinolones / administration & dosage*
  • Randomized Controlled Trials as Topic
  • Respiratory Function Tests
  • Scopolamine Derivatives / administration & dosage*
  • Tiotropium Bromide


  • Adrenergic beta-Agonists
  • Bronchodilator Agents
  • Indans
  • Quinolones
  • Scopolamine Derivatives
  • indacaterol
  • Tiotropium Bromide