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  • Title: [Indacaterol--a new hope for maximising bronchodilation?].
    Author: Mihălţan F.
    Journal: Pneumologia; 2011; 60(1):21-5. PubMed ID: 21548196.
    Abstract:
    Development new treatments for chronic obstructive respiratory disease is still a far away dream. Naturally, researchers focused on improving efficiency of existent molecules. A new beta-2 adrenergic class was born recently: the ultra-LABA's. First player that was already adopted in current practice is indacaterol. Indacaterol is a beta-2 adrenergic rapidly acting, with an onset of action in 5 minutes, like salbutamol and formoterol but with a sustained bronchodilator effect, that last for 24 hours, like tiotropium. Indacaterol clinical study program, INERGIZE, followed three main directions: prove superiority over placebo, evaluate indacaterol among others established bronchodilators routinely used in COPD management and establish long-term safety profile. In patients with moderate-severe COPD, indacaterol, both 150 and 300 microg showed a rapidly and sustained improvement in pulmonary function, increasing FEV1 with 130-180 ml (p < 0.001) versus placebo (INLIGHT 1). Comparing to salmeterol, there was a superior improvement in FEV1, that starts from day 1 and last unchanged till the end of study (p < 0.01 vs salmeterol; INLIGHT 2). Over 12 mcg formoterol twice daily, 300 microg indacaterolul, once daily showed superiority in improving pulmonary (p < 0.001 vs formoterol; Involve), that is present form day 2, with no ceiling effects over one year, unlike formoterol. As an outcome for secondary objectives, indacaterol proved superior improvement in breathlessness at 12 weeks, (TDI score, p < 0.01 vs formoterol). Regarding exacerbations, indacaterol was at least as effective in reducing exacerbations, as formoterol. Open-label study over tiotropium, INHANCE, compared indacaterol, 150 and 300 microg, with tiotropium, 18 microg, both once daily, for 6 month. At 12 weeks, primary objective for all indacaterol studies, both indacaterol doses showed FEV1 improvement of 180 ml versus 140 ml for tiotropium (p < or = 0.01). % of patients with improvement in TDI score > 1 unit at the end of the study was in favour of indacaterol 300 microg (p < or = 0.01). Authors conclusion was that once daily indacaterol is at least as effective as tiotropium, in its symptoms and health status. The availability of a new once daily bronchodilator, that maximize efficiency of beta-2 adrenergics may provide clinicians with more flexibility in treating COPD, and may increase adherence to treatments for patients.
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