Am Fam Physician. 2014;90(4):252-254
Author disclosure: No relevant financial affiliations.
Indacaterol (Arcapta) is an inhaled, once-daily long-acting beta agonist (LABA) labeled for the treatment of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.
| Drug | Starting dosage | Dose form | Cost* |
|---|---|---|---|
| Indacaterol (Arcapta) | 75 mcg per day | Neohaler inhaler (one capsule) | $198 |
SAFETY
Indacaterol causes few serious adverse effects. However, because LABAs as a class are associated with an increased risk of asthma-related deaths, indacaterol is not labeled for the treatment of asthma.1 Although indacaterol has not been studied to determine its long-term effects, other LABAs have been shown to be safe in patients with COPD.2 The LABA class slightly increases mortality and COPD exacerbations when used as monotherapy without inhaled corticosteroids.3
Indacaterol can increase pulse and systolic and diastolic blood pressures, and can prolong the QTc interval. As with other LABAs, indacaterol should not be used with other sympathomimetic drugs, medications that can prolong the QTc interval, or beta blockers.1
TOLERABILITY
Indacaterol is well tolerated; the most common adverse effect is cough following administration (6.5%).1 Additional adverse effects are similar to those of other LABAs.1,4–6 Rates of discontinuation from clinical studies because of adverse effects were similar to those of patients receiving placebo.7
EFFECTIVENESS
There is reliable evidence that indacaterol significantly improves overall health status, quality of life, and symptoms of dyspnea when compared with placebo. It also reduces the number of days of poor control of COPD and need for rescue medication.2,4,6,7 An analysis of pooled results suggests that indacaterol in a dosage of 150 to 300 mcg once daily is at least as effective as formoterol (Foradil), salmeterol (Serevent Diskus), and tiotropium (Spiriva) in improving these outcomes.7 It is important to note that a starting dosage of indacaterol is 75 mcg per day, but there are no comparative studies using this dosage. There is some evidence that suggests indacaterol is superior to the other agents in decreasing the need for rescue medications, but the differences are small and may not be clinically relevant.2,4,6,7
PRICE
A one-month supply of indacaterol (75 mcg per day) costs approximately $198. In comparison, a one-month supply of salmeterol (50 mcg twice a day) costs approximately $220 and a one-month supply of formoterol (12 mcg twice a day) costs approximately $219.
SIMPLICITY
The contents of one capsule of indacaterol are used once daily at the same time of day with the supplied Neohaler inhaler, which is similar to the inhaler for tiotropium. No dosage adjustment is required for older adults or for patients with renal impairment or mild to moderate hepatic impairment.1
Bottom Line
Indacaterol provides a similar benefit to other long-acting bronchodilators for the treatment of moderate to severe COPD, with once-daily dosing. As with other LABAs, it should be used only as add-on therapy in patients already taking inhaled corticosteroids.
