Indacaterol/glycopyrronium versus salmeterol/fluticasone in Asian patients with COPD at a high risk of exacerbations: results from the FLAME study.

Background: The FLAME study demonstrated that indacaterol/glycopyrronium (IND/GLY), the fixed-dose combination of a long-acting β ₂ -agonist (LABA, IND) and a long-acting muscarinic antagonist (LAMA, GLY), was superior to salmeterol/fluticasone combination (SFC) in preventing exacerbations in COPD patients with a high risk of exacerbations. In this study, we report a prespecified analysis of the efficacy and safety of IND/GLY versus SFC in Asian patients from the FLAME study.
Patients and Methods: Patients from Asian centers with moderate-to-very severe COPD and ≥1 exacerbation in the previous year from the 52-week, randomized FLAME study were included. IND/GLY was compared versus SFC for effects on exacerbations, lung function (forced expiratory volume in 1 second [FEV ₁ ] and forced vital capacity [FVC]), health status (St George's Respiratory Questionnaire [SGRQ]), rescue medication use, and safety.
Results: A total of 510 Asian patients (IND/GLY, n=250 or SFC, n=260) were included. Compared to the overall FLAME population, the Asian cohort had more males, a shorter duration of COPD, fewer patients using inhaled corticosteroid (ICS) at screening, fewer current smokers, and more patients with very severe COPD. IND/GLY significantly reduced the rate of moderate/severe exacerbations (rate ratio: 0.75; 95% confidence interval: 0.58-0.97; P =0.027) and prolonged time to first moderate/severe exacerbation versus SFC (hazard ratio: 0.77; 95% confidence interval: 0.59-1.01; P =0.055). Predose trough FEV ₁ and FVC significantly improved in Asian patients ( P <0.001). IND/GLY improved SGRQ for COPD (SGRQ-C score; P =0.006) and reduced rescue medication use ( P =0.058) at week 52. Pneumonia incidence was 3.6% with IND/GLY and 7.7% with SFC ( P =0.046).
Conclusion: In exacerbating Asian COPD patients, IND/GLY was more effective than SFC.
Competing Interests: JAW has received no honoraria from industry for lectures and/or advisory boards from January 2015. Prior to January 2015 she received honoraria for lectures and/or advisory boards from Novartis, GSK, Astra Zeneca, Boehringer Ingelheim, Takeda, and Johnson and Johnson. JAW has received research grant funding in the last 3 years from Johnson and Johnson, Takeda, GSK, and Vifor Pharma. MI has served on Scientific Advisory Boards for AstraZeneca, Nippon Boehringer Ingelheim, and Novartis Pharma KK from January 2015. MI has received honoraria for speaking from AstraZeneca, GSK, Nippon Boehringer Ingelheim, Kyorin, and Novartis Pharma in 2015. NZ does not have any competing interests to declare. MH, RF, CT, FP, and DB are Novartis employees. The authors report no other conflicts of interest in this work.