Indacaterol therapy in moderate-to-severe chronic obstructive pulmonary disease: findings from a single-center primary care cohort

Abstract

Background: Once-daily long-acting β2-agonists (LABAs) are an important treatment option, either alone or in combination with other inhaled long-acting bronchodilators in the management of chronic obstructive pulmonary disease (COPD).

Aims/objectives: To audit the effectiveness of indacaterol as maintenance therapy in patients with moderate-to-severe COPD (Global initiative for chronic Obstructive Lung Disease [GOLD] stage II/III).

Methods: This was a single-center audit of a primary care COPD cohort comprising all patients treated with indacaterol following treatment escalation (as per National Institute for Health and Care Excellence guidelines) or failure with other therapies. The sample was restricted to patients treated for a minimum of 12 months with indacaterol, for whom preswitching and follow-up spirometry as well as exacerbation frequency data were available (GOLD spirometry guidelines). Pulmonary function was assessed by spirometry (recorded as forced expiratory volume in 1 second [FEV1] expressed as percentage predicted). Relevant self-reported qualitative information was recorded in descriptive terms for quality of life (QoL) assessment.

Results: A total of 15 patients met the audit inclusion criteria (66.6% male, mean age 64.9±7.7 years). COPD disease duration ranged from 1 to 22 years; 93% had GOLD stage II or III COPD. Follow-up ranged in duration from 12 to 27 months. Indacaterol was associated with a significant reduction in exacerbation frequency compared with the 12 months prior to initiation (P=0.02). In those patients who experienced three or more exacerbations/year, mean exacerbation rate fell from 5.43±1.07 to 2.43±0.2 after 12 months treatment with indacaterol (P=0.02). A reduction in dyspnea was noted in 53% of patients. Similarly, improvements in exercise tolerance and well-being were self-reported in 67% and 93%, respectively.

Conclusion: Indacaterol was found to be an effective LABA as an escalation or switch medication in patients with moderate-to-severe COPD. Indacaterol was effective both as monotherapy and in combination with a long-acting muscarinic antagonist. Switching to indacaterol from a LABA/inhaled corticosteroid fixed-combination inhaler significantly reduced the number of acute exacerbations and also improved self-reported QoL.

Keywords: audit; bronchodilators; chronic obstructive pulmonary disease; effectiveness; indacaterol; primary care.

Figure 1

(A) Spirometry (FEV₁% predicted) prior to switching and after a minimum of 12 months of indacaterol treatment. Complete spirometry data were available for 14 patients. Prior to switching, the mean (SD) FEV₁% predicted across all these patients was 54.5% (15.8%), and at the last assessment (after a minimum of 12 months on indacaterol) 57.1% (20.4%). No statistical differences in pre- and postswitching spirometry were seen, either for the cohort as a whole (P=0.39) or for comparisons based upon disease severity. (B) Individual percentage change in FEV₁% predicted after a minimum of 12 months of indacaterol. Changes were seen on an individual patient basis. In five patients, notable improvement in spirometry was seen, while in five patients deterioration was observed; in four patients, FEV₁ was relatively unchanged. Abbreviations: FEV₁, forced expiratory volume in 1 second as a percentage of forced vital capacity; SD, standard deviation.

Figure 2

(A) Mean annual exacerbation rates immediately prior to and after a minimum of 12 months of indacaterol therapy. Exacerbation frequency was available in 13 patients. (range 0–10, mean 3.31±0.87, SD=3.15). Following switching to indacaterol, mean exacerbation rate fell significantly (range 0–3, mean 1.54±0.31, SD=1.13; P=0.02). In six patients classified as suffering frequent (three or more per year) exacerbations, mean exacerbation rate fell significantly from 5.43±1.07 to 2.43±0.2 after 12 months treatment with indacaterol (P=0.02). *P=0.02. (B) Individual annual exacerbation rates in the 12 months prior to switching and the last 12 months of indacaterol treatment. On an individual patient basis, a reduction in frequency of acute exacerbations was seen in nine of 13 patients (69%). Abbreviation: SD, standard deviation.