Indacaterol/glycopyrronium affects lung function and cardiovascular events in patients with chronic obstructive pulmonary diseases: A meta-analysis

Qinxia Zhang; Haifu Zhang; Jianjun Wang; Zhaoyang Ruan; Yifan Dai; Zehai Xia; Qun Lv

doi:10.1016/j.hrtlng.2021.02.018

Indacaterol/glycopyrronium affects lung function and cardiovascular events in patients with chronic obstructive pulmonary diseases: A meta-analysis

Heart Lung. 2021 Jul-Aug;50(4):532-541. doi: 10.1016/j.hrtlng.2021.02.018. Epub 2021 Apr 14.

Authors

Qinxia Zhang¹, Haifu Zhang², Jianjun Wang³, Zhaoyang Ruan³, Yifan Dai³, Zehai Xia¹, Qun Lv⁴

Affiliations

¹ Division of Respiratory Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China; School of Medicine, Hangzhou Normal University, Hangzhou, China.
² School of Medicine, Hangzhou Normal University, Hangzhou, China.
³ Division of Respiratory Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China.
⁴ Division of Respiratory Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China. Electronic address: hzlvqun@126.com.

PMID: 33865004
DOI: 10.1016/j.hrtlng.2021.02.018

Abstract

Background: Bronchodilators are the cornerstone for treating patients with chronic obstructive pulmonary diseases (COPD), although some studies have shown that dual bronchodilators may exacerbate incidence of adverse cardiovascular events. Here, we evaluated the cardiopulmonary safety of indacaterol/glycopyrronium (IND/GLY) using a meta-analysis.

Methods: We searched PubMed, OVID, Cochrane Library and Web of Science databases, using "indacaterol/glycopyrronium", "indacaterol/glycopyrrolate", "IND/GLY", "QVA149", "chronic obstructive pulmonary diseases", "COPD", "chronic obstructive airway disease", "chronic obstructive lung disease" as key words. Acute exacerbation of COPD and FEV₁ as indicators of pulmonary function and occurrence of hypertension, atrial fibrillation, myocardial infarction and heart failure as indicators of cardiovascular safety.

Results: A total of 23 articles, comprising 21,238 participants, were included in the analysis. FEV₁ values were significantly different compared to IND/GLY and single bronchodilator therapy (LABA or LAMA), with the MD 0.11 L (95%CI: 0.10-0.13, P<0.01). Hypertension was more frequent in the IND/GLY, than the single bronchodilator therapy group, although this difference was insignificant (IND/GLY vs LABA, RR=1.88, P = 0.09; IND/GLY vs LAMA, RR=1.42, P = 0.08; IND/GLY vs LABA+ICS, RR=1.85, P = 0.23). In addition, IND/GLY did not significantly increase the risk of myocardial infarction (IND/GLY vs LAMA or double therapy, total RR: 1.49, 95%CI: 0.72-3.08, P = 0.28), atrial fibrillation (IND/GLY vs LAMA, RR: 1.62, 95%CI: 0.64-4.10, P = 0.31) and heart failure (IND/GLY vs LAMA, RR: 0.40, 95%CI: 0.07-2.33, P = 0.31) in COPD patients.

Conclusions: IND/GLY significantly reduced incidence of acute COPD exacerbations, and slowed down the decline of FEV₁. Adequate safety measures are needed to control incidence of adverse cardiovascular events.

Keywords: Cardiovascular events; Indacaterol/glycopyrronium; Lung function.

Publication types

Meta-Analysis

MeSH terms

Administration, Inhalation
Adrenergic beta-2 Receptor Agonists / therapeutic use
Bronchodilator Agents / adverse effects
Cardiovascular Diseases* / chemically induced
Cardiovascular Diseases* / epidemiology
Forced Expiratory Volume
Glycopyrrolate / adverse effects
Humans
Indans
Lung
Muscarinic Antagonists / adverse effects
Pulmonary Disease, Chronic Obstructive* / complications
Pulmonary Disease, Chronic Obstructive* / drug therapy
Quinolones
Treatment Outcome

Substances

Adrenergic beta-2 Receptor Agonists
Bronchodilator Agents
Indans
Muscarinic Antagonists
Quinolones
indacaterol
Glycopyrrolate