Advantages of indacaterol, once-daily ultra long-acting beta2-agonist for asthma and COPD

Once-daily beta2-agonists or ultra long-acting beta2-agonists (LABAs) are under development for asthma and COPD. Arcapta Neohaler (indacaterol) is the only once-daily ultra-LABA approved for COPD maintenance (


under development for treatment of asthma and COPD include:

- carmoterol
- indacaterol. Related: The Risks and Benefits of Indacaterol - NEJM review and 16-min podcast. NEJM, 2011.
- several GSK molecules

Long-acting antimuscarinic agents (LAMAs)

New long-acting antimuscarinic agents (LAMAs) include:

- aclidinium
- LAS-35201
- 2 GSK products
- NVA-237 (glycopyrrolate)
- OrM3

LABA plus LAMA combinations

Several options for once-daily dual-action ultra LABA plus LAMA combination products are currently being evaluated. Dimer molecule in which both LABA and LAMA are present is called M3 antagonist-beta2 agonist (MABA) bronchodilators

Indacaterol advantages

Single doses of indacaterol is effective for 24-h bronchodilation and well tolerated in patients with persistent asthma The Risks and Benefits of Indacaterol - NEJM review and 16-min podcast. NEJM, 2011.

Indacaterol had a greater effect than formoterol on FEV1: 17.7% vs. 7.5%, respectively, from pre-dose. Comparison of once daily indacaterol and twice daily formoterol: a greater effect of indacaterol on resting IC and FEV1

Indacaterol showed bronchodilator efficacy throughout the full 24-hour period, rapid onset of action, good safety

Mast cell stabilization may constitute another therapeutic benefit of indacaterol in addition to bronchodilation

Bronchodilator efficacy of indacaterol at 24 h post-dose was at least as efficacious as formoterol 12 microg BID

Indacaterol trough FEV1 levels compared favorably with the improvement seen with tiotropium in COPD patients

Indacaterol as a partnering agent for combinations: LABA/ICS and LABA/LAMA

Indacaterol is an attractive partnering agent for fixed combinations in both asthma and COPD, e.g. daily ICS or LAMA


Anticholinergic (Tiotropium) Plus a Low-Dose Glucocorticoid May Effectively Control Asthma
The Risks and Benefits of Indacaterol - NEJM review and 16-min podcast. NEJM, 2011.
Image source: Indacaterol, Wikipedia, public domain.


  1. Hmm... "good safety" is from a trial of 25 participants that received 2 doses. I would not count on that!

  2. Thank you for your comment, Martin.

    I am sure we will see a lot more data on indacaterol this year.

  3. Yes, I'm eager to see if it's a new, useful tool - or a potentially risky choice like other LABAs.