Drug products: Atectura Breezhaler, Enerzair Breezhaler, Onbrez® Breezhaler®, Ultibro Breezhaler
ATC code: R03AC18, R03AK14, R03AL04, R03AL12
Substances: indacaterol, indacaterol acetate, indacaterol maleate
More men than women have been included in the randomized controlled trials of indacaterol in chronic obstructive pulmonary disease (COPD). A large pooled analysis found that indacaterol/glycopyrronium improved lung function more than placebo and other active substances in both men and women, although improvements in health status, dyspnea, rescue medication use, and symptoms were generally larger in women than in men. A post-hoc analysis of sex differences in the annualized rates of COPD exacerbations was found to be lower in men treated with indacaterol/glycopyrronium than those treated with salmeterol/ fluticasone. There was no significant effect in women, which may be due to a low number of women included in this study. No sex differences were found regarding safety.
Indacaterol is a long-acting beta2-agonist (LABA) used for treating airflow obstruction in patients with COPD [1, 2]. Data from various studies indicate that women have increased dyspnea for a given level of airflow limitation and greater airway hyper-responsiveness, as well as greater frequency of exacerbations .
Pharmacokinetics and dosing
Cmax has been found to be 11% higher in women . A population pharmacokinetic study found smoking, age, and patient's sex to affect apparent clearance of indacaterol . Neither of these differences are perceived to be clinically relevant and no dose adjustment according to patient’s sex is recommended [1,2,4,5].
A pooled analysis of the IGNITE program (4719 men, 1389 women) comparing the effect by sex of indacaterol/glycopyrronium on moderate to very severe COPD versus other commonly used COPD treatments and placebo found indacaterol/glycopyrronium to improve lung function more than placebo and other active comparators in both men and women. Improvements in health status, dyspnea, rescue medication use, and symptoms were generally larger in women than in men .
In a post-hoc analysis of sex differences in the randomized controlled FLAME trial in patients with moderate-to very severe COPD (2257 men, 805 women) the annualized rates of moderate/severe as well as all exacerbations were lower in men treated with indacaterol/glycopyrronium than those treated with salmeterol/ fluticasone. The difference was not significant in women. Time-to-first moderate/severe COPD exacerbation was lower in both indacaterol/glycopyrronium treated men and women. If this reflects the lower number of women in the study or a true difference in efficacy is not clear .
A pooled analysis of safety data from 14 randomized studies on fixed dose indacaterol/glycopyrronium, the monocomponents, or comparators in patients with COPD (in total 8 334 men, 3 064 women) found no difference in adverse events between men and women .
Reproductive health issues
Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
Date of litterature search: 2019-05-28
- Arcapta (indacaterol). DailyMed [www]. US National Library of Medicine. [updated 2018-12-16, cited 2019-05-28]. länk
- Onbrez Breezhaler (indakaterol). Summary of Product Characteristics. European Medicines Agency [updated 2018-08-31, cited 2019-05-28].
- Wedzicha JA, Singh D, Tsiligianni I, Jenkins C, Fucile S, Fogel R et al. Treatment response to indacaterol/glycopyrronium versus salmeterol/fluticasone in exacerbating COPD patients by gender: a post-hoc analysis in the FLAME study. Respir Res. 2019;20(1):4. PubMed
- Cazzola M, Calzetta L, Page CP, Matera MG. Use of indacaterol for the treatment of COPD: a pharmacokinetic evaluation. Expert Opin Drug Metab Toxicol. 2014;10(1):129-37. PubMed
- Demin I, Bartels C, Graham G, Bieth B, Gautier A, Tillmann HC et al. Population pharmacokinetics of IND/GLY (indacaterol/glycopyrronium) in COPD patients. Int J Clin Pharmacol Ther. 2016;54(6):405-15. PubMed
- Tsiligianni I, Mezzi K, Fucile S, Kostikas K, Shen S, Banerji D et al. Response to Indacaterol/Glycopyrronium (IND/GLY) by Sex in Patients with COPD: A Pooled Analysis from the IGNITE Program. COPD. 2017;14(4):375-381. PubMed
- Wedzicha JA, Dahl R, Buhl R, Schubert-Tennigkeit A, Chen H, D'Andrea P et al. Pooled safety analysis of the fixed-dose combination of indacaterol and glycopyrronium (QVA149), its monocomponents, and tiotropium versus placebo in COPD patients. Respir Med. 2014;108(10):1498-507. PubMed
- Statistikdatabas för läkemedel. Stockholm: Socialstyrelsen. 2020 [cited 2021-03-10.] länk
Reviewed by: Karin Schenck-Gustafsson
Approved by: Karin Schenck-Gustafsson