Indacaterol was introduced as an agent of the new generation of very long acting beta2-agonists (VLABA) that
provides a 24-hour activity of bronchodilation and allows a once-daily OD dosing. The first trial showed a significantly
higher efficacy of indacaterol vs. placebo in patients with chronic obstructive pulmonary disease (COPD). The following
trials were aimed at evaluating its performance compared with other bronchodilators. The results can be summarized in a
comparable efficacy of indacaterol, mainly assessed by the increase in FEV1 value but also by quality of life and other patient-
reported outcomes (PROs), compared with the OD antimuscarinic tiotropium bromide, and in a slightly higher efficacy
compared with the LABA formoterol and salmeterol administered twice-daily. No problems of safety and tolerability
were reported in the trials as well as in specific studies, every kind of adverse event, including cardiovascular effects, being
similarly frequent with indacaterol and with placebo. Concerning the real-life management, in respect to LABA, the
OD dosing makes indacaterol more convenient for COPD patients and is likely to positively influence the patient’s adherence.
Since adherence to medical treatment of chronic diseases, and particularly COPD is a crucial issue in medicine, such
aspect should confer to indacaterol a valuable role in clinical practice. The recently approved combination of indacaterol
with the antimuscarinic glycopyrronium [QVA149], based on the demonstration of positive effects on both lung function
and PROs, is likely to be a further option for patients with severe COPD.
Adherence, bronchodilators, chronic obstructive pulmonary disease, efficacy, indacaterol, long-acting beta2-
Pulmonary Rehabilitation Unit, ICP Hospital, Via Bignami 1, Milan, Italy.