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.