Comparative efficacy of aclidinium versus glycopyrronium and tiotropium, as maintenance treatment of moderate to severe COPD patients: a systematic review and network meta-analysis

Karabis, A.; Lindner, Leandro; Mocarski, Michelle; Huisman, Eline; Greening, A P

doi:10.2147/copd.s48967

Cited by 36 publications

(34 citation statements)

References 36 publications

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“…(1) Karabis and colleagues conducted a network meta-analysis which demonstrated that AB produced similar improvements in lung function, health-related quality of life, and dyspnea compared with TIO-SMI, TIO-DPI, and GPM [Karabis et al 2013]. (2) Pharmacotherapies in COPD have never been shown to improve TIO-DPI, tiotropium-dry powder inhaler; TIO-SMI, tiotropium-soft mist inhaler.…”

Section: Discussionmentioning

confidence: 99%

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Comparative efficacy of long-acting muscarinic antagonists in preventing COPD exacerbations: a network meta-analysis and meta-regression

Oba

Lone

2015

Ther Adv Respir Dis

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Background: We hypothesized a class effect of currently available long-acting muscarinic antagonists (LAMAs; i.e. tiotropium as a dry powder inhaler or a soft mist inhaler, aclidinium bromide, and glycopyrronium) in preventing chronic obstructive pulmonary disease (COPD) exacerbations. The hypothesis was tested with a network meta-analysis. Methods: Several databases and manufacturer's websites were searched for relevant clinical trials. Randomized, controlled trials, of at least 12 weeks duration, comparing a LAMA with placebo or another LAMA were included. Moderate-to-severe and severe exacerbations were chosen as the outcome assessment criteria. The data were pooled using network metaanalysis. Results: A total of 27 studies with 48,140 subjects were included. All LAMAs reduced moderate-to-severe exacerbations compared with placebo. However, there were no statistically significant differences in preventing moderate-to-severe or severe exacerbations among LABAs. In a subgroup analysis restricting studies to those that had a minimum of 6 months of treatment, glycopyrronium was associated with the least-effective strategy and aclidinium was associated with the greatest probability of being the best therapy in preventing severe exacerbations. Our meta-regression analysis suggested that the prevention of COPD exacerbations were less effective in studies which allowed concomitant use of a long-acting beta agonist (LABA). Conclusion: All LAMAs were equally effective in preventing moderate-to-severe exacerbations. Aclidinium was associated with the lowest risk for severe exacerbations when treatment duration was 6 months or longer. The concomitant use of LABA may not enhance the efficacy of LAMAs in preventing COPD exacerbations. More studies are needed to further examine above findings.Keywords: aclidinium bromide, glycopyrronium, tiotropium , 2004]. The purpose of this study was to systematically review the efficacy of available LAMA formulations in preventing COPD-related exacerbations with a MTC meta-analysis. To assess the impact of LAMAs on moderate-tosevere and severe exacerbations, data were extracted in the form of rates and given as the number of events per person-years observed. When the number of events was not available in a given study, we substituted the number of subjects who experienced an exacerbation. We assumed that each of the log hazard ratios had been sampled from a normal distribution and that the hazard was constant in each arm over the follow-up period. We gave vague priors for all trial baselines, treatment effects, and between-trial variances. The probability that each LAMA formulation was associated with being the most efficacious treatment was calculated by counting the proportion of iterations of the Markov chain in which each LAMA formulation had the highest HR. The surface under the cumulative ranking (SUCRA), which is a simple numerical summary of these probabilities, was also calculated. The SUCRA would be 100% when a treatment is certain to be the best and 0% when a treat...

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Section: Discussionmentioning

confidence: 99%

“…Karabis and colleagues conducted a network meta-analysis comparing AB, TIO-SMI, TIO-DPI and GPM and concluded that AB was as effective as other LAMAs in improving lung function, health-related qualify of life and symptoms [Karabis et al 2013]. However, COPDrelated exacerbations were not included in their analysis.…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy of long-acting muscarinic antagonists in preventing COPD exacerbations: a network meta-analysis and meta-regression

Oba

Lone

2015

Ther Adv Respir Dis

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“…This estimation was based on the assumption that CFB for post-bronchodilator FEV 1 was equal to CFB for FEV 1 trough (ie, the use of a short-acting β 2 -agonist for the postbronchodilator measurement would not affect the CFB FEV 1 values). The CFB values for FEV 1 trough for each arm were estimated with a network meta-analysis (NMA) 17. Finally, the FEV 1 % predicted was calculated at 12 and 24 weeks as the ratio of post-bronchodilator FEV 1 /predicted FEV 1 .…”

Section: Methodsmentioning

confidence: 99%

“…The results of an NMA for the CFB trough FEV 1 endpoints at 12 and 24 weeks were used in the economic model to estimate the decline of the FEV 1 % predicted during the first 24 weeks of the time horizon as a result of the efficacy of treatments (short-term changes in trough FEV 1 ). NMA results of the comparison between aclidinium 400 μg bid and tiotropium 18 μg od were taken from a larger NMA that also compared aclidinium 400 μg bid and tiotropium 5 μg od;17 however, since tiotropium 5 μg od is not a relevant comparator in the United States, a scenario analysis was performed comparing only aclidinium 400 μg bid and tiotropium 18 μg od, and these latter results were used to populate the present model. NMA results were used, as no long-term studies have been conducted comparing aclidinium and tiotropium 20.…”

Section: Methodsmentioning

confidence: 99%

Economic evaluation of aclidinium bromide in the management of moderate to severe COPD: an analysis over 5 years

Karabis¹,

Mocarski²,

Eijgelshoven³

et al. 2014

CEOR

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PurposeAclidinium bromide is a long-acting muscarinic antagonistic used in maintenance treatment of chronic obstructive pulmonary disease (COPD). A model-based health economic study evaluated the cost-effectiveness of aclidinium 400 μg bid as an alternative to tiotropium 18 μg od for this indication in the US.Patients and methodsPatient characteristics in this model reflect those in the aclidinium clinical studies: age >40 years, stable moderate-to-severe COPD, current or ex-smokers (>10 pack-years), post-salbutamol forced expiratory volume in 1 second (FEV1) ≥30% and <80% of predicted normal value, and FEV1/forced vital capacity <70%. The model consists of five main health states indicating severity of COPD and the level of utility, resource use, and costs. Treatment efficacy over 5 years was modeled using FEV1% predicted; a network meta-analysis comparing aclidinium and tiotropium was used to estimate disease progression during the first 24 weeks, and results from the UPLIFT trial were used for time points after 24 weeks. Quality of life was assessed using utility scores in US patients from the UPLIFT trial. Cost-effectiveness was assessed as the incremental cost per quality-adjusted life year (QALY) gained.ResultsOver 5 years, QALYs were 3.50 for aclidinium versus 3.49 for tiotropium; life years accumulated were 4.52 for both. In this economic model, aclidinium versus tiotropium showed marginally fewer exacerbations (3.364 versus 3.390, respectively) and mean total health care costs (US$126,274 versus US$128,591, respectively). In all scenario analyses performed (discount factors of 0% and 6% for benefits and costs; time horizon of 1 year; mapping St George’s Respiratory Questionnaire to European Quality of Life–5 Dimensions; excluding pharmacy costs, COPD-related cost only; cost of exacerbations; including ACCORD II trial in the network meta-analysis), aclidinium was associated with lower costs and marginally greater QALYs versus tiotropium.ConclusionAclidinium is potentially cost-effective compared with tiotropium for maintenance treatment of moderate-to-severe COPD.

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“…Maintenance treatment with aclidinium should be expected to provide similar results to tiotropium in patients with moderate-to-severe COPD. 43 As noted above, the vast majority of published clinical trials to date compare aclidinium bromide with placebo to assess its effect on FEV 1 and COPD symptoms. Although published data are limited, current ongoing clinical trials are directly comparing aclidinium, alone or in combination with formoterol, to formoterol or salmeterol/fluticasone.…”

Section: Comparative Clinical Trialsmentioning

confidence: 99%

The Role of Aclidinium Bromide in the Treatment of Chronic Obstructive Pulmonary Disease

et al. 2014

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Comparative efficacy of aclidinium versus glycopyrronium and tiotropium, as maintenance treatment of moderate to severe COPD patients: a systematic review and network meta-analysis

Cited by 36 publications

References 36 publications

Comparative efficacy of long-acting muscarinic antagonists in preventing COPD exacerbations: a network meta-analysis and meta-regression

Comparative efficacy of long-acting muscarinic antagonists in preventing COPD exacerbations: a network meta-analysis and meta-regression

Economic evaluation of aclidinium bromide in the management of moderate to severe COPD: an analysis over 5 years

The Role of Aclidinium Bromide in the Treatment of Chronic Obstructive Pulmonary Disease

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