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.

中文翻译：

---

茚达特罗/格隆铵影响慢性阻塞性肺疾病患者的肺功能和心血管事件：一项荟萃分析

背景

支气管扩张剂是治疗慢性阻塞性肺疾病（COPD）患者的基石，尽管一些研究表明，双重支气管扩张剂可能会加剧不良心血管事件的发生率。在这里，我们使用荟萃分析评估了茚达特罗/格隆溴铵（IND / GLY）的心肺安全性。

方法

我们搜索了PubMed，OVID，Cochrane图书馆和Web of Science数据库，使用“茚达特罗/格隆溴铵”，“茚达特罗/格隆溴铵”，“ IND / GLY”，“ QVA149”，“慢性阻塞性肺疾病”，“ COPD”，“慢性” “阻塞性气道疾病”，“慢性阻塞性肺疾病”为关键词。COPD和FEV _1的急性加重是肺功能的指标，高血压，心房纤颤，心肌梗塞和心力衰竭的发生是心血管安全性的指标。

结果

分析共包括23篇文章，包括21,238名参与者。与IND / GLY和单支气管扩张剂治疗（LABA或LAMA）相比，FEV ₁值显着不同，MD为0.11 L（95％CI：0.10-0.13，P <0.01）。与单支气管扩张剂治疗组相比，IND / GLY的高血压发生率更高（尽管差异不明显（IND / GLY与LABA，RR = 1.88，P  = 0.09； IND / GLY与LAMA，RR = 1.42，P  = 0.08） ； IND / GLY vs LABA + ICS，RR = 1.85，P  = 0.23）。此外，IND / GLY并没有显着增加心肌梗死的风险（IND / GLY与LAMA或双重治疗，总RR：1.49，95％CI：0.72-3.08，P = 0.28），房颤（IND / GLY vs LAMA，RR：1.62，95％CI：0.64–4.10，P  = 0.31）和心力衰竭（IND / GLY vs LAMA，RR：0.40，95％CI：0.07–2.33 ，P  = 0.31）。

结论

IND / GLY显着降低了急性COPD急性发作的发生率，并减缓了FEV ₁的下降。需要采取足够的安全措施来控制不良心血管事件的发生率。