Indacaterol is an ultra long acting beta agonist that is currently only FDA approved to treat COPD. Indacaterol containing inhalers have shown promise in 2 recent phase 3 trials in patients with severe uncontrolled asthma. For both trials, the endpoint was measured on spirometry and it studied the FEV1 after 26 weeks of treatment.
In the PALLADIUM trial, that was published in the Lancet of Respiratory Medicine, July 202, it found that a combination of indacaterol and mometasone (a steroid), it improved the FEV1 and symptom control as assessed by the Asthma control questionnaire compared to mometasone alone. The study showed that it was “noninferior” to fluticasone-salmeterol (Advair, Wixela).
Building on that study, in the IRIDIUM trial, it showed that indacaterol-glycopyrronium-mometasone triple therapy improved FEV1 as compared to indacaterol-mometasone or fluticasone-salmeterol. Overall these results show that adding once-daily indacaterol may improve disease control in patients with severe asthma.
Currently there are severe LABA/ICS combination medications available; Advair, Symbicort, Dulera and Breo. Breo is the only once daily one available combo medication ICS/LABA. Trelegy was recently approved for asthma and it is a triple combination therapy.
There are many medications available for patients in this class. In the end, indacaterol will likely be released in the combination form and it will show that it works well. Whether or not it works better than the existing medications that are currently available remains to be seen.
Many of the medications used to treat COPD also show benefit to treat asthma, although the diseases are entirely different, the commonality of airway obstruction does show responses to the same medications (inhaled steroids, long acting beta agonists and long acting muscarinic antagonist (LAMA).
To read more about LAMA and LABA medications, see the link below.