NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Norris SL, Yen PY, Dana TL, et al. Drug Class Review: Beta2-Agonists: Final Report [Internet]. Portland (OR): Oregon Health & Science University; 2006 Nov.

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Drug Class Review: Beta2-Agonists

Drug Class Review: Beta2-Agonists: Final Report [Internet].

Show details

Conclusions

Table 21Summary of the evidence by Key Question

Key QuestionQuality of Evidence (No. effectiveness or AE studies and quality)Conclusions
1. When used in adults with asthma or chronic obstructive pulmonary disease (COPD), are there differences in efficacy or effectiveness among long-acting, inhaled beta2-agonists, when used in the outpatient setting?Salmeterol vs formoterol: 7 fair, 1 poorSalmeterol vs formoterol: Among asthma patients, NSD between these drugs (delivered via dry powder devices) for symptoms (3 studies), use of rescue medications (3), healthcare utilization (2) and quality of life (1). Among COPD patients, 2 studies found NSD between drugs for respiratory symptoms (1 MDI, 1 dry powder devices); no other effectiveness outcomes were examined. In EIA in adults, 1 single-dose study (dry poweder delivery) found NSD in FEV1 after exercise; formoterol had faster onset of action and greater % increase in FEV1 prior to exercise.
2. When used in adults with asthma or COPD, are there differences in efficacy or effectiveness among the following short-acting inhaled beta2-agonists when used in the outpatient setting: albuterol, fenoterol, levalbuterol, pirbuterol, metaproterenol and terbutaline?Albuterol vs levalbuterol: 2 fair

Albuterol vs metaproterenol: 0

Albuterol vs pirbuterol: 0

Metaproterenol vs pirbuterol: 0

Comparisons of interest to Canada:
Fenoterol vs albuterol: 1 fair, 1 poor
Terbutaline vs albuterol: 2 fair, 3 poor
Fenoterol vs metaproterenol: 0
Terbutaline vs fenoterol: 3 fair
Terbutaline vs metaproterenol: 0
Terbutaline vs pirbuterol: 0
Albuterol vs levalbuterol: Among adults with asthma, 1 RCT found less rescue medication use with levalbuterol (no between-group statistics) with no apparent difference in symptoms. A controlled clinical trial in the ER found a decrease in need for additional treatment with levalbuterol compared to comparable albuterol dosages, but hospital admission rates were similar. No data in COPD or EIA.

Albuterol vs metaproterenol: No effectiveness data.

Albuterol vs pirbuterol: No effectiveness data.

Metaproterenol vs pirbuterol: No effectiveness data.

Comparisons of interest to Canada:
Fenoterol vs albuterol: No effectiveness data.
Terbutaline vs albuterol: In adult asthma patients, there was NSD in rescue medication use (3 studies). In COPD, there were no effectiveness data.
Fenoterol vs metaproterenol: No effectiveness data.
Terbutaline vs fenoterol: NSD symptoms scores (1 study)
Terbutaline vs metaproterenol: No effectiveness data.
Terbutaline vs pirbuterol: No effectiveness data.
3. When used in children with asthma, are there differences in efficacy or effectiveness among long-acting, inhaled beta2-agonists, when used in the outpatient setting?Salmeterol vs formoterol: 1 fairSalmeterol vs formoterol: 1 study comparing dry powder formulations showed similar symptom outcomes between groups; parent-assessed QOL (activity), SABA use, and some specific symptoms scores improved more for formoterol.
4. When used in children with asthma, are there differences in efficacy or effectiveness among the following short-acting inhaled beta2-agonists when used in the outpatient setting: albuterol, fenoterol, levalbuterol, pirbuterol, metaproterenol and terbutaline?Albuterol vs levalbuterol: 1 good, 4 fair

Albuterol vs metaproterenol: 1 fair

Albuterol vs pirbuterol: 1 fair

Metaproterenol vs pirbuterol: 0

Comparisons of interest to Canada:
Fenoterol vs albuterol: 1 good, 5 fair
Terbutaline vs albuterol: 1 good, 3 fair
Fenoterol vs metaproterenol: 0
Terbutaline vs fenoterol: 3 fair
Terbutaline vs metaproterenol: 0
Terbutaline vs pirbuterol: 0
Albuterol vs levalbuterol: Daily regular use (2 studies): NSD between drugs for symptoms and use of rescue medications with 21-day use; fewer asthma control days with levalbuterol 0.63 and albuterol 1.25 compared to levalbuterol 0.31 day 14–21 (p<0.04); NSD uncontrolled days in 2nd study Emergency room treatment (3 studies); NSD symptoms (2 studies), need for additional treatments (3), ER length of stay (2); Hospital admissions: NSD in two studies; third study found fewer admissions with levalbuterol 1.25 mg 3 doses vs albuterol 2.5 mg 3 doses, (P=0.02). This latter study was larger and was powered to detect a difference in this outcome. This result needs to be replicated in other settings.

Albuterol vs metaproterenol: EIA: Equally efficacious in blocking bronchospasm initially; duration of action of albuterol was greater than for metaproterenol
Albuterol vs pirbuterol: No effectiveness data.
Metaproterenol vs pirbuterol: No effectiveness data.

Comparisons of interest to Canada:
Fenoterol vs albuterol: No effectiveness data.
Terbutaline vs albuterol: In pediatric asthma, there was NSD in symptoms (3 studies).
Fenoterol vs metaproterenol: No effectiveness data.
Fenoterol vs terbutaline: No effectiveness data.
Terbutaline vs metaproterenol: No effectiveness data.
Terbutaline vs pirbuterol: No effectiveness data.
5. When used in adults with asthma or COPD, are there differences in safety or rates of adverse events among long-acting, inhaled beta2-agonists, when used in the outpatient setting?Salmeterol vs formoterol: 4 fair, 2 poorSalmeterol vs formoterol: Withdrawal rates (total and AE-related) were similar. NSD heart rate at 2h (formotoerol 24ug and salmeterol 50ug ) (1 study) and up to 24 hours (formoterol 12ug and salmeterol 50ug) (1 study). Palpitations and ventricular premature beats more common with formoterol (2 studies; 1 with formoterol 12ug bid and 1 with single dose 24ug [an unapproved dose]); NSD at approved doses (1 study). Decrease potassium more in formoterol (1 study). NSD tremor (3) and headache (4).
6. When used in adults with asthma or COPD, are there differences in safety or rates of adverse events among the following short-acting inhaled beta2-agonists when used in the outpatient setting: albuterol, fenoterol, levalbuterol, pirbuterol, metaproterenol and terbutaline?Albuterol vs levalbuterol: 2 fair

Albuterol vs metaproterenol: 0

Albuterol vs pirbuterol: 0
Metaproterenol vs pirbuterol: 0

Comparisons of interest to Canada:
Fenoterol vs albuterol: 1 poor
Terbutaline vs albuterol: 3 fair, 2 poor
Fenoterol vs metaproterenol: 0
Terbutaline vs fenoterol: 2 fair, 1 poor
Terbutaline vs metaproterenol: 0
Terbutaline vs pirbuterol: 0
Albuterol vs levalbuterol: NSD withdrawal rates (3 studies). Heart rate increases with both drugs (3); increase more with albuterol (1). NSD BP (1), palpitations (1), tachycardia (1), increased blood glucose (1), dizziness/nervousness/anxiety/tremor (5). Decreased potassium: NSD between drugs (4); potassium decreased more with albuterol 2.5mg tid than levalbuterol 0.63 mg tid (p<0.05) (1).
Albuterol vs metaproterenol: NSD BP, HR (1 study); no other AE data.
Albuterol vs pirbuterol: No comparative AE data.
Metaproterenol vs pirbuterol: NSD withdrawals, headache, dizziness, tremors, nausea, nervousness (1 study)

Comparisons of interest to Canada:
Fenoterol vs albuterol: Blood pressure decreased 1–6 (7 studies) mm Hg after both drugs and heart rate response varied (−5 to +15 BBM) after treatment (9). Decrease in K+ with NSD between groups (2).
Terbutaline vs albuterol: Similar effects on BP (1 study). Heart rate increased 5–15 BBM with NSD (4). K+ decreased approximately 0.5 meq/L in both drugs (1). Headache rare in both drugs (2).
Fenoterol vs metaproterenol: Sparse data on comparative safety.
Terbutaline vs fenoterol: Sparse data on comparative safety.
Terbutaline vs metaproterenol: Sparse data on comparative safety.
Terbutaline vs pirbuterol: Sparse data on comparative safety.
7. When used in children with asthma, are there differences in safety or rates of adverse events among long-acting, inhaled beta2-agonists, when used in the outpatient setting?Salmeterol vs formoterol: 1 poorSalmeterol vs formoterol: Withdrawals greater with formoterol (1 study). NSD between groups for: headaches (1), tremor (1), palpitations (1), respiratory infections (1). No data on potassium.
8. When used in children with asthma, are there differences in safety or rates of adverse events among the following short-acting inhaled beta2-agonists, when used in the outpatient setting: albuterol, fenoterol, levalbuterol, pirbuterol, metaproterenol and terbutaline?Albuterol vs levalbuterol: 1 good, 3 fair
Albuterol vs metaproterenol: 0
Albuterol vs pirbuterol: 0
Metaproterenol vs pirbuterol: 0

Comparisons of interest to Canada:
Fenoterol vs albuterol: 0
Terbutaline vs albuterol: 1 good, 3 fair
Fenoterol vs metaproterenol: 0
Terbutaline vs fenoterol: 0
Terbutaline vs metaproterenol: 0
Terbutaline vs pirbuterol: 0
Albuterol vs levalbuterol: Withdrawal rates variable (2 studies); NSD increase heart (3 studies); no data on BP; NSD tremor (1), light-headedness (1), dizziness (1), nervousness (1). Blood glucose increased with both drugs, more with albuterol (1). NSD decrease K+ (1); lower K+ with albuterol (1 study at day 0, NSD day 21; 2nd study provided no data).
Albuterol vs metaproterenol: No data on comparative effectiveness
Albuterol vs pirbuterol: No data on comparative effectiveness
Metaproterenol vs pirbuterol: No data on comparative effectiveness

Comparisons of interest to Canada: (results pending)
Fenoterol vs albuterol: No data on withdrawals. Increase heart rate 2–25 BBM in both drugs with NSD (3). No BP data. No data on K+, blood glucose, neurologic AEs.
Terbutaline vs albuterol: Heart rate response variable with no pattern or difference between drugs (3). No BP data. K+ decreased approximately 0.5 meq/L in both drugs (1). No neurological comparative data.
Fenoterol vs metaproterenol: Sparse data on comparative safety.

Terbutaline vs fenoterol; Sparse data on comparative safety.
Terbutaline vs metaproterenol: Sparse data on comparative safety.
Terbutaline vs pirbuterol: Sparse data on comparative safety.
9. Are there subgroups of patients based on demographic characteristics (age, racial groups, gender), other medications (drug-drug interactions), comorbidities (drug-disease interactions), or pregnancy for which one long-acting, inhaled beta2-agonsts is more efficacious, effective, or associated with fewer adverse events than another inhaled beta2-agonst?Salmeterol vs formoterol: 5 fairSalmeterol vs formoterol: Older, male COPD patients: Efficacy (5 studies), effectiveness (1), withdrawals (1) and AEs (5) were similar between the two drugs. No data on race or comorbidities.
10. Are there subgroups of patients based on demographic characteristics (age, racial groups, gender), other medications (drug-drug interactions), comorbidities (drug-disease interactions), or pregnancy for which one of the following short-acting, inhaled beta2-agonsts is more efficacious, effective, or associated with fewer adverse events: albuterol, levalbuterol, pirbuterol, and metaproterenol?Albuterol vs levalbuterol: 1 fair
Albuterol vs metaproterenol: 1 fair, 1 poor
Albuterol vs pirbuterol; 1 fair
Metaproterenol vs pirbuterol: 1 fair

Comparisons of interest to Canada:
No data on subgroups identified.
Albuterol vs levalbuterol: Older, predominantly male COPD population: NSD in efficacy, heart rate, tremor; no effectiveness data in this study. No data on race or comorbidities.

Albuterol vs metaproterenol: In older COPD patients, NSD efficacy between drugs (2 studies).

Albuterol vs pirbuterol: In older COPD patients, NSD efficacy between drugs (1 fair).

Metaproterenol vs pirbuterol: In older COPD patients, NSD efficacy between drugs (1).

Comparisons of interest to Canada: No data on subgroups identified.
Copyright © 2006, Oregon Health & Science University, Portland, Oregon.
Bookshelf ID: NBK10427

Views

Other titles in this collection

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...